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Fillenbaum GG, Mohs R. CERAD (Consortium to Establish a Registry for Alzheimer's Disease) Neuropsychology Assessment Battery: 35 Years and Counting. J Alzheimers Dis 2023; 93:1-27. [PMID: 36938738 PMCID: PMC10175144 DOI: 10.3233/jad-230026] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND In 1986, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) was mandated to develop a brief neuropsychological assessment battery (CERAD-NAB) for AD, for uniform neuropsychological assessment, and information aggregation. Initially used across the National Institutes of Aging-funded Alzheimer's Disease Research Centers, it has become widely adopted wherever information is desired on cognitive status and change therein, particularly in older populations. OBJECTIVE Our purpose is to provide information on the multiple uses of the CERAD-NAB since its inception, and possible further developments. METHODS Since searching on "CERAD neuropsychological assessment battery" or similar terms missed important information, "CERAD" alone was entered into PubMed and SCOPUS, and CERAD-NAB use identified from the resulting studies. Use was sorted into major categories, e.g., psychometric information, norms, dementia/differential dementia diagnosis, epidemiology, intervention evaluation, genetics, etc., also translations, country of use, and alternative data gathering approaches. RESULTS CERAD-NAB is available in ∼20 languages. In addition to its initial purpose assessing AD severity, CERAD-NAB can identify mild cognitive impairment, facilitate differential dementia diagnosis, determine cognitive effects of naturally occurring and experimental interventions (e.g., air pollution, selenium in soil, exercise), has helped to clarify cognition/brain physiology-neuroanatomy, and assess cognitive status in dementia-risk conditions. Surveys of primary and tertiary care patients, and of population-based samples in multiple countries have provided information on prevalent and incident dementia, and cross-sectional and longitudinal norms for ages 35-100 years. CONCLUSION CERAD-NAB has fulfilled its original mandate, while its uses have expanded, keeping up with advances in the area of dementia.
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Affiliation(s)
- Gerda G Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Richard Mohs
- Global Alzheimer's Platform Foundation, Washington, DC, USA
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Hsu JL, Hsu WC, Chang CC, Lin KJ, Hsiao IT, Fan YC, Bai CH. Everyday cognition scales are related to cognitive function in the early stage of probable Alzheimer's disease and FDG-PET findings. Sci Rep 2017; 7:1719. [PMID: 28496183 PMCID: PMC5431919 DOI: 10.1038/s41598-017-01193-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/27/2017] [Indexed: 02/02/2023] Open
Abstract
We applied the Everyday Cognition (ECog) scale in normal aging adults and patients with Alzheimer’s disease (AD) to investigate associations between neuropsychological tests and neuroimaging markers. A total of 160 normal aging adults and 40 patients with the early stage of probable AD were included. Neuropsychological performance was assessed using the Consortium to Establish a Registry for Alzheimer’s Disease Neuropsychological Assessment Battery (CERAD-NAB). 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) scans were used to measure AD-related hypometabolism. Nonparametric Spearman correlation analysis was used to study associations between ECog and z-transformed total CERAD-NAB scores in both groups. The results revealed a significant correlation between total ECog and CERAD-NAB scores (rho = −0.28, p < 0.01), and category verbal fluency test with the executive domain of the ECog scale (rho = −0.20, p < 0.01). The CERAD-NAB scores were also significantly correlated with AD-related hypometabolism (rho = −0.49, p < 0.01). The memory domain of the ECog scale was significantly correlated with FDG uptake in the angular gyrus and posterior cingulum gyrus (rho = −0.41 and −0.46, P < 0.01). In conclusion, both total and memory domain ECog scores were correlated with the neuropsychological tests and neuroimaging biomarkers.
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Affiliation(s)
- Jung-Lung Hsu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Taoyuan, Taiwan.,Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan.,Brain and Consciousness Research Center, Taipei Medical University, Taipei, Taiwan.,Dementia Center and Section of Dementia, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Chuin Hsu
- Dementia Center and Section of Dementia, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chiung-Chih Chang
- Department of Neurology, Cognition and Aging Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kun-Ju Lin
- Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Ing-Tsung Hsiao
- Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Chun Fan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan. .,Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Yancar Demir E, Özcan T. Evaluating the relationship between education level and cognitive impairment with the Montreal Cognitive Assessment Test. Psychogeriatrics 2015; 15:186-90. [PMID: 25560276 DOI: 10.1111/psyg.12093] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 10/20/2014] [Accepted: 10/28/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is defined as 'a cognitive decline greater than that expected for an individual's age and education level but that does not interfere notably with activities of daily life'. The Montreal Cognitive Assessment (MoCA) is a screening test for MCI. METHODS We investigated the performance of the Turkish version of the MoCA in detecting MCI among elderly persons in a rural area, the majority of whom have a low level of education. We evaluated 50 consecutive men referred from an outpatient clinic. Educational level was divided into three categories: group 1, less than primary (<5 years); group 2, primary (5 years); group 3, more than primary (>5 years). We evaluated the effect of education on MoCA scores and compared subjects' test performance among the different categories of education level. RESULTS A total of 50 male patients with MCI (mean age: 70.74 ± 7.87) met the inclusion criteria. There were no differences in the total scores based on education or in the subscores for visuospatial/executive function, naming, attention, abstraction and delayed recall. Language was the only domain that showed significant differences between the groups. In post-hoc analysis, differences were found between groups 1 and 3 and between groups 1 and 2. Group 1 had significantly lower scores for language. The repeat subscore for language was significantly lower in group 1 than in group 2. In fluency, there were significant differences between groups 2 and 3 and between group 1 and 3. CONCLUSION To our knowledge, this is the first study to analyze the applicability of the Turkish version of MoCA in populations with little education. Our results emphasize the need to adapt the language sections of this test, so it can be easily used in populations with low education levels.
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Affiliation(s)
- Esra Yancar Demir
- Department of Psychiatry, School of Medicine, Ordu University, Ordu, Turkey
| | - Tuba Özcan
- Department of Neurology, School of Medicine, Ordu University, Ordu, Turkey
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Karrasch M, Laatu S, Ellfolk U, Marttila R, Martikainen K. Education-corrected CERAD identifies MCI and dementia in Parkinson's disease. Acta Neurol Scand 2015; 131:219-24. [PMID: 25273524 DOI: 10.1111/ane.12310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study examined whether controlling for educational background in the CERAD cognitive screening battery would affect the likelihood of patients with Parkinson's disease to fulfill criteria for mild cognitive impairment (PD-MCI) and dementia (PDD). MATERIALS & METHODS One-hundred seventeen patients with PD were studied. Cognitive impairment was determined as two subtest scores falling below either the standard cutoff scores or education-corrected cutoff scores. The presence of dementia was determined by clinical interview or Clinical Dementia Rating. Patients were then classified as PD-MCI and PDD according to cognitive test performance and presence/absence of dementia. RESULTS The number of cognitively impaired patients (PD-MCI or PDD) was significantly higher when education-controlled cutoff scores were used (62.5% vs 38%). Correspondingly, the number of false negatives (demented PD patients performing normally in CERAD) was significantly lower when education-corrected cutoff scores were used (4% vs 10%). CONCLUSIONS Controlling for education increases the sensitivity of the CERAD for PD-MCI and PDD.
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Affiliation(s)
- M. Karrasch
- Department of Psychology and Logopedics; Abo Akademi University; Turku Finland
| | - S. Laatu
- Outpatient Ward of Neuropsychiatry; Turku University Hospital; Turku Finland
| | - U. Ellfolk
- Department of Psychology and Logopedics; Abo Akademi University; Turku Finland
| | - R. Marttila
- Division of Clinical Neurosciences; Turku University Hospital; Turku Finland
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Hallikainen I, Martikainen J, Lin PJ, Cohen JT, Lahoz R, Välimäki T, Hongisto K, Väätäinen S, Vanhanen M, Neumann PJ, Hänninen T, Koivisto AM. The Progression of Alzheimer's Disease Can Be Assessed with a Short Version of the CERAD Neuropsychological Battery: The Kuopio ALSOVA Study. Dement Geriatr Cogn Dis Extra 2014; 4:494-508. [PMID: 25685140 PMCID: PMC4296232 DOI: 10.1159/000369159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background/Aims Measuring and predicting Alzheimer's disease (AD) progression is important in order to adjust treatment and allocate care resources. We aimed to identify a combination of subtests from the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Battery (CERAD-NB) that best correlated with AD progression in follow-up as well as to predict AD progression. Method A total of 236 participants with very mild [Clinical Dementia Rating (CDR) = 0.5] or mild AD (CDR = 1.0) at baseline were followed up for 3 years. The CERAD-NB and Mini-Mental State Examination (MMSE) were used to assess cognition, and the CDR scale sum of boxes (CDR-sb) was employed to evaluate AD progression. Generalized estimating equations were used to develop models to predict and follow up disease progression. Results Performance declined on all CERAD-NB subtests. The ability of the separate subtests to distinguish between groups (baseline CDR = 0.5 or 1.0) diminished during follow-up. The best combination of subtests that explained 62% of CDR-sb variance in follow-up included verbal fluency, constructional praxis, the clock drawing test, and the MMSE. Baseline values of the same combination predicted 37% of the CDR-sb change. Conclusion A short version of the CERAD-NB subtests provides a promising and time-efficient alternative for measuring cognitive deterioration during AD follow-up. Although the initial signs of AD include memory difficulties, it may be useful to assess non-memory tasks in follow-up.
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Affiliation(s)
- Ilona Hallikainen
- School of Educational Sciences and Psychology, Kuopio, Finland ; Neurology, Institute of Clinical Medicine, Kuopio, Finland
| | - Janne Martikainen
- Pharmacoeconomics and Outcomes Research Unit, School of Pharmacy, Kuopio, Finland
| | - Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass., USA
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass., USA
| | | | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland ; Development, Clinical Education and Research Unit of Nursing, Kuopio, Finland
| | | | - Saku Väätäinen
- Pharmacoeconomics and Outcomes Research Unit, School of Pharmacy, Kuopio, Finland
| | | | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass., USA
| | - Tuomo Hänninen
- Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Anne Maria Koivisto
- Neurology, Institute of Clinical Medicine, Kuopio, Finland ; Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
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A normative study of total scores of the CERAD neuropsychological assessment battery in an educationally diverse elderly population. Int Psychogeriatr 2014; 26:1897-904. [PMID: 25075438 DOI: 10.1017/s1041610214001379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aimed to investigate the influences of age, education, and gender on the two total scores (TS-I and TS-II) of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological assessment battery (CERAD-NP) and to provide normative information based on an analysis for a large number of elderly persons with a wide range of educational levels. METHODS In the study, 1,987 community-dwelling healthy volunteers (620 males and 1,367 females; 50-90 years of age; and zero to 25 years of education) were included. People with serious neurological, medical, and psychiatric disorders (including dementia) were excluded. All participants underwent the CERAD-NP assessment. TS-I was generated by summing raw scores from the CERAD-NP subtests, excluding Mini-Mental State Examination and Constructional Praxis (CP) recall subtests. TS-II was calculated by adding CP recall score to TS-I. RESULTS Both TS-I and TS-II were significantly influenced by demographic variables. Education accounted for the greatest proportion of score variance. Interaction effect between age and gender was found. Based on the results obtained, normative data of the CERAD-NP total scores were stratified by age (six overlapping tables), education (four strata), and gender. CONCLUSIONS The normative information will be very useful for better interpretation of the CERAD-NP total scores in various clinical and research settings and for comparing individuals' performance of the battery across countries.
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Vadikolias K, Tsiakiri-Vatamidis A, Tripsianis G, Tsivgoulis G, Ioannidis P, Serdari A, Heliopoulos J, Livaditis M, Piperidou C. Mild cognitive impairment: effect of education on the verbal and nonverbal tasks performance decline. Brain Behav 2012; 2:620-7. [PMID: 23139907 PMCID: PMC3489814 DOI: 10.1002/brb3.88] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 06/22/2012] [Accepted: 07/22/2012] [Indexed: 11/30/2022] Open
Abstract
We sought to longitudinally evaluate the potential association of educational level with performance on verbal and nonverbal tasks in individuals with mild cognitive impairment (MCI). We evaluated patients with MCI, age >50 years, no medication intake, absent vascular risk factors, and no lesions on brain magnetic resonance imaging (MRI). Each patient underwent a clinical assessment packet and a series of neuropsychological tests of the language and constructional praxis subtests of Cambridge Cognitive Examination (CAMGOG) and the Boston naming test (BNT), at baseline, 6 months, and 12 months. Educational levels were defined taking into account the total years of education, the school level, and diplomas. MCI patients with low education level showed a stepwise reduction in scores of naming objects (NO; P = 0.009), definition (DF; P = 0.012), language (LT; P = 0.021), constructional praxis (CD; P = 0.022), confrontation naming skills (BXB; P = 0.033), phonemic help (BFB; P = 0.041), and BNT (P = 0.002). Analysis of covariance, controlling for baseline scores, showed that education was associated with NO score (P = 0.002), DF score (P = 0.005), LT (P = 0.008), CD score (P = 0.008), BXB score (44.36 ± 1.84, P = 0.0001), BFB (P = 0.022), and BNT (P = 0.004). Our findings indicate that education appeared to affect verbal and nonverbal task performance in MCI patients. Despite the fact that higher educated patients are more acquainted with the tasks, slower deterioration in consecutive follow-up examinations could be explained by the cognitive reserve theory. The potential association of this protective effect with delayed onset of symptoms deserves further investigation.
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Affiliation(s)
- Konstantinos Vadikolias
- Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis Greece
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Hallikainen I, Koivisto AM, Paajanen T, Hiltunen A, Karppi P, Vanhanen M, Välimäki T, Herukka SK, Soininen H, Hänninen T. Cognitive and Neuropsychiatric Symptom Differences in Early Stages of Alzheimer's Disease: Kuopio ALSOVA Study. Dement Geriatr Cogn Dis Extra 2012; 2:209-18. [PMID: 22719747 PMCID: PMC3379731 DOI: 10.1159/000338231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background/Aim Alzheimer's disease (AD) causes impairment in memory and other cognitive functions as well as neuropsychiatric symptoms and limitations in the activities of daily living (ADL). The aim of this study was to examine whether demographic variables, dementia severity, ADL and neuropsychiatric symptoms are associated with cognition in very mild or mild AD. Methods We analyzed the baseline data of 236 patients with very mild or mild AD participating in a prospective AD follow-up study (ALSOVA). The Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery total score was used in the evaluation of the global cognitive performance. Results Cognition was associated with dementia severity and ADL but not with neuropsychiatric symptoms. ADL functions were associated with both cognitive performance and neuropsychiatric symptoms. Conclusion Even patients with very mild or mild AD may exhibit neuropsychiatric symptoms not related to cognitive impairment. The results of this study emphasize the importance of taking a multidimensional approach to the diagnostic and prognostic evaluation of AD patients already in the early stages of the disease.
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Affiliation(s)
- Ilona Hallikainen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Mikkeli, Finland
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Sotaniemi M, Pulliainen V, Hokkanen L, Pirttilä T, Hallikainen I, Soininen H, Hänninen T. CERAD-neuropsychological battery in screening mild Alzheimer's disease. Acta Neurol Scand 2012; 125:16-23. [PMID: 21198445 DOI: 10.1111/j.1600-0404.2010.01459.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery (nb) is used as an evaluation tool for dementia. In Finland, CERAD-nb was introduced in 1999 and has been proposed to be used in primary health care. However, some of its parts need reassessment and focusing. The goal of this study was to examine the sensitivity and specificity of the subtests and their cut-off points most appropriate for identifying mild Alzheimer's disease (AD). MATERIALS AND METHODS The study population consisted of 171 patients with mild AD and 315 cognitively normal elderly. Both groups underwent CERAD-nb investigation as a part of a wider examination procedure. RESULTS The most efficient subtests to discriminate patients with mild AD from the normal elderly were Wordlist delayed recall and savings, Wordlist learning and Wordlist recognition and a new variable of Total recall. Optimal cut-off points for each subtest are suggested. The sensitivities of the verbal memory subtests varied between 0.75 and 0.94, the specificities between 0.80 and 0.93 and the areas under the receiver operating characteristics curve between 0.89 and 0.96. CONCLUSIONS The CERAD-nb is capable of differentiating cases with mild AD from normal elderly individuals particularly with its verbal memory subtests. New cut-off scores for CERAD's subtests validated in the study further enhance the differentiating power, and with these clarifications, CERAD-nb is considered appropriate to be used as a screening tool for AD even in primary health care.
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Affiliation(s)
- M Sotaniemi
- Department of Psychology, Institute of Behavioural Sciences, University of Helsinki, Finland.
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Fillenbaum GG, Burchett BM, Unverzagt FW, Rexroth DF, Welsh-Bohmer K. Norms for CERAD constructional praxis recall. Clin Neuropsychol 2011; 25:1345-58. [PMID: 21992077 DOI: 10.1080/13854046.2011.614962] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Recall of the four-item constructional praxis measure was a later addition to the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery. Norms for this measure, based on cognitively intact African Americans age ≥70 (Indianapolis-Ibadan Dementia Project, N=372), European American participants age ≥66 (Cache County Study of Memory, Health and Aging, N=507), and European American CERAD clinic controls age ≥50 (N = 182), are presented here. Performance varied by site; by sex, education, and age (African Americans in Indianapolis); education and age (Cache County European Americans); and only age (CERAD European American controls). Performance declined with increased age, within age with less education, and was poorer for women. Means, standard deviations, and percentiles are presented separately for each sample.
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Affiliation(s)
- Gerda G Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, USA.
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Fillenbaum GG, van Belle G, Morris JC, Mohs RC, Mirra SS, Davis PC, Tariot PN, Silverman JM, Clark CM, Welsh-Bohmer KA, Heyman A. Consortium to Establish a Registry for Alzheimer's Disease (CERAD): the first twenty years. Alzheimers Dement 2008; 4:96-109. [PMID: 18631955 DOI: 10.1016/j.jalz.2007.08.005] [Citation(s) in RCA: 277] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Accepted: 08/17/2007] [Indexed: 10/22/2022]
Abstract
The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) was funded by the National Institute on Aging in 1986 to develop standardized, validated measures for the assessment of Alzheimer's disease (AD). The present report describes the measures that CERAD developed during its first decade and their continued use in their original and translated forms. These measures include clinical, neuropsychological, neuropathologic, and behavioral assessments of AD and also assessment of family history and parkinsonism in AD. An approach to evaluating neuroimages did not meet the standards desired. Further evaluations that could not be completed because of lack of funding (but where some materials are available) include evaluation of very severe AD and of service use and need by patient and caregiver. The information that was developed in the U.S. and abroad permits standardized assessment of AD in clinical practice, facilitates epidemiologic studies, and provides information valuable for individual and public health planning. CERAD materials and data remain available for those wishing to use them.
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Affiliation(s)
- Gerda G Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA.
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Kemppainen NM, Aalto S, Karrasch M, Någren K, Savisto N, Oikonen V, Viitanen M, Parkkola R, Rinne JO. Cognitive reserve hypothesis: Pittsburgh Compound B and fluorodeoxyglucose positron emission tomography in relation to education in mild Alzheimer's disease. Ann Neurol 2008; 63:112-8. [PMID: 18023012 DOI: 10.1002/ana.21212] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The reduced risk for Alzheimer's disease (AD) in high-educated individuals has been proposed to reflect brain cognitive reserve, which would provide more efficient compensatory mechanisms against the underlying pathology, and thus delayed clinical expression. Our aim was to find possible differences in brain amyloid ligand 11C-labeled Pittsburgh Compound B ([11C]PIB) uptake and glucose metabolism in high- and low-educated patients with mild AD. METHODS Twelve high-educated and 13 low-educated patients with the same degree of cognitive deterioration were studied with PET using [11C]PIB and 18F-fluorodeoxyglucose as ligands. The between-group differences were analyzed with voxel-based statistical method, and quantitative data were obtained with automated region-of-interest analysis. RESULTS High-educated patients showed increased [11C]PIB uptake in the lateral frontal cortex compared with low-educated patients. Moreover, high-educated patients had significantly lower glucose metabolic rate in the temporoparietal cortical regions compared with low-educated patients. INTERPRETATION Our results suggesting more advanced pathological and functional brain changes in high-educated patients with mild AD are in accordance with the brain cognitive reserve hypothesis and point out the importance of development of reliable markers of underlying AD pathology for early AD diagnostics.
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Affiliation(s)
- Nina M Kemppainen
- Turku Positron Emission Tomography Centre, University of Turku, Turku, Finland
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13
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Pavlik VN, Doody RS, Massman PJ, Chan W. Influence of premorbid IQ and education on progression of Alzheimer's disease. Dement Geriatr Cogn Disord 2007; 22:367-77. [PMID: 16954693 DOI: 10.1159/000095640] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lower education is associated with a higher risk of developing Alzheimer's disease (AD). Years of education and measures of general intellectual function (IQ) are highly correlated. It is important to determine whether there is a relationship between education and AD outcomes that is independent of IQ. OBJECTIVE To test the hypothesis that premorbid IQ is a stronger predictor of cognitive decline, global progression, and overall survival, than education in patients with AD. METHODS The study included 478 probable AD patients (322 women and 156 men, mean age 74.5 years) followed in a large AD referral center for a mean of 3.2 years. Eligible participants had a baseline estimate of premorbid IQ using the American version of the Nelson Adult Reading Test (AMNART) and at least one follow-up visit with complete neuropsychological assessment. We used random effects linear regression analysis, and Cox proportional hazards analysis to determine whether or not education and/or premorbid IQ were independently associated with cognitive decline, global progression of AD, and survival. RESULTS When the baseline AMNART score was included in regression models along with education and other demographic variables, AMNART score, but not education, was associated with a higher baseline score and slower rate of decline in MMSE and ADAS-Cog scores, and the Clinical Dementia Rating sum of boxes score. Neither higher premorbid IQ nor higher education was associated with longer survival. CONCLUSIONS We conclude that a baseline AMNART score is a better predictor of cognitive change in AD than education, but neither variable is associated with survival after diagnosis.
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Affiliation(s)
- V N Pavlik
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77098-3926, USA.
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Lilja A, Hämäläinen P, Kaitaranta E, Rinne R. Cognitive impairment in spinocerebellar ataxia type 8. J Neurol Sci 2005; 237:31-8. [PMID: 15958266 DOI: 10.1016/j.jns.2005.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2004] [Revised: 01/25/2005] [Accepted: 05/12/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Only a limited number of studies have investigated the cognitive performances of spinocerebellar ataxia (SCA) patients. In none of the SCA8 studies have the neuropsychological test performances been the primary measures. The objective of the current study was to investigate the characteristics of cognitive deficits in SCA8. METHODS Ten SCA8 patients and ten case-by-case matched control subjects underwent a comprehensive neuropsychological examination evaluating attention and information processing, concept formation, reasoning and executive functions, verbal production, memory and learning and visuoperceptual and -constructive functions. RESULTS SCA8 patients demonstrated deficits primarily in attention and information processing, as well as in concept formation, reasoning, executive functions and verbal production. Visuoperceptual and -constructive functions, as well as most of the performances of memory were unaffected. CONCLUSIONS Cognitive impairments, especially those related to attention, information processing and executive functions, seem to be a clinical feature of SCA8 disease.
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Affiliation(s)
- Arja Lilja
- Masku Neurological Rehabilitation Centre, P.O. Box 15, FIN-21251 Masku, Finland.
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Karrasch M, Sinervä E, Grönholm P, Rinne J, Laine M. CERAD test performances in amnestic mild cognitive impairment and Alzheimer's disease. Acta Neurol Scand 2005; 111:172-9. [PMID: 15691286 DOI: 10.1111/j.1600-0404.2005.00380.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The aim of the study was to examine the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) test performances cross-sectionally in patients suffering from amnestic mild cognitive impairment (MCI) and mild Alzheimer's disease (AD). Moreover, we wanted to determine the sensitivity to amnestic MCI and mild AD, as well as the specificity of different CERAD subtests in our study groups. MATERIAL AND METHODS Fifteen healthy elderly individuals, 15 amnestic MCI patients and 15 probable AD patients suffering from mild dementia were tested with the CERAD neurocognitive dementia screening test. RESULTS Significant differences were found in all CERAD tests except Constructional praxis (copy) and Clock drawing between the controls and the AD group. The MCI group was differentiated from the controls only in the Wordlist learning test. In the language tests the sensitivity to MCI and AD was quite low and the specificity very high. In the savings scores the sensitivity to AD was high, but the specificity rather low. The Wordlist recognition test screened no false positives using the current cut-off score and the sensitivity to AD was 0.6, but only one MCI patient was detected using the current cut-off score. Raising the cut-off score also raised the sensitivity to MCI without dramatic loss of specificity. Cut-off scores for the Wordlist learning test and Wordlist delayed recall, which have been found to differentiate normal aging from dementia, are lacking in the Finnish CERAD. The current data indicates that the Wordlist learning test might be relatively sensitive to MCI. CONCLUSIONS The results indicate that the Finnish CERAD test battery with its current cut-off scores has low sensitivity to MCI, and using it as a sole cognitive screening instrument for MCI and preclinical dementia might result in false negatives.
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Affiliation(s)
- M Karrasch
- Department of Psychology, Abo Akademi University, Abo, Finland.
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Current awareness in geriatric psychiatry. Int J Geriatr Psychiatry 2003; 18:1149-56. [PMID: 14870737 DOI: 10.1002/gps.794] [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: 11/07/2022]
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