NEUROPSYCHOMETRIC TESTS

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1 NEUROPSYCHOMETRIC TESTS

2 CAMCOG It is the Cognitive section of Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) The measure assesses orientation, language, memory, praxis, attention, abstract thinking, perception and calculation

3 CAMCOG-2

4 CAMDEX It consists of three main sections: A structured clinical interview with the patient to obtain systematic information about the present condition, past history and family history; a range of objective cognitive tests which constitute a mini-neuropsychological battery; a structured interview with a relative or other informant to obtain independent information about the respondent's present state, past history and family history. Roth M et al. CAMDEX. A standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia1986 Br J Psychiatry

5 CAMDEX-2 The CAMDEX test is acceptable to patients, has a high inter-rater reliability and the cognitive section has been shown to have high sensitivity and specificity.

6 Mini Mental State Examination (MMSE) It is brief 30- point questionnaire test that is used to screen for cognitive impairment (especially in MCI and AD patients)

7 Questions asked 'What is the date, day, month, year? 'Listen carefully. I am going to say three words. You say them back after I stop. Ready? Here they are APPLE [pause], PENNY [pause], TABLE [pause]. Now repeat those words back to me. 'What is this?' [Point to a pencil or pen.] 'Please read this and do what it says.' [Show examinee the following words on the stimulus form.] CLOSE YOUR EYES

8 MMSE-2 Orientation to time Orientation to place Registration Attention & Calculation Recall Language 5 points 5 points 3 points 5 points 3 points 9 points

9 Risk of Developing Alzheimer s Disease in Persons with MCI Survival curve of persons characterized as having a mild cognitive impairment for 6 years. Approximately 80% have converted to dementia during this time. Peterson RC, et al., Arch Neurol. 58: , 2001.

10 MMSE Specificity is good (96%) But the sensitivity is poor (63%) Using a standard cutoff score of 24 will leave a substantial proportion of cases of early dementia undetected. Asking patients and knowledgeable informants about deficits may enhance detection of early stages of AD abnormalities in learning and retaining new information difficulty handling complex tasks impaired reasoning ability changes in language or behavioral alterations

11 Available Screening Tests MMSE Too long min 7-Minute Screen 7 10 min Too complex Clock Drawing Test Not sensitive 2 4 min Mini-cog 3 5 min Complex scoring, unclear adequacy Memory Impairment Screen 4 min Need for slightly shorter, easier test (a suitably accurate test that takes less than 2 minutes is not available)

12 ALZHEIMER S DISEASE Estimate MMSE as a function of time MMSE score Estimated years into illness AAMI / MCI/ early AD -- DEMENTIA Ashford et al., 1995

13 Global Deterioration Scale-1 Stage 1 Stage 2 Stage 3 Stage 4 Normal; no memory complaints and no evident cognitive impairment. Very mild; memory problem reported, but not evident in clinical interview. Mild impairment in memory, concentration, and occupational performance. Moderate impairment in memory, knowledge retrieval, and complex tasks.

14 ADAS-Cog (Alzheimer Disease Assessment Scale- Cognitive) It consists of 11 tasks measuring the disturbances of memory, language, praxis, attention and other cognitive abilities which are known as the core symptoms of AD It is used in multicentric studies focused on studying the intensity of main symptoms of dementia as well as assessing the effect of the treatment. Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer's disease. Am J Psychiatry Nov;141(11):

15 ADAS-Cog-2

16 Global Deterioration Scale-2 Stage 5 Moderate to severe impairment in both recent and remote memory, frequent disorientation to time and place, and impairment in ADLs that indicates need for caregiver assistance. Stage 6 Severe impairment with inability to tend to ADLs without assistance. Stage 7 Very severe impairment in cognition, language, and motor skills, progressing to a less functional, vegetative state.

17 Hamilton rating scale (HDRS) 21-question multiple choice questionnaire that the clinicians may use to rate the severity of a patient s major depression The questionnaire rates the severity of symptoms observed in depression such as low mood, insomnia, agitation, anxiety and weight loss Hamilton, M (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry

18 Functional cognitive assessment scale (FUCAS) It is a new reliable cognitive- behavioral scale that assesses executive function in daily life activities directly in patients with dementia. FUCAS can discriminate patients with MCI from those with moderate-severe dementia Kounti et al., 2006

19 FRSSD (Functional Rating Scale for Symptoms of Dementia) It tests executive function

20 Trail making test (A,B) Neuropsychological test of visual attention and task switching. The task requires a subject to connect the dots' of 25 consecutive targets on a sheet of paper or computer screen. Reitan R. M. (1958). Validity of the Trail Making test as an indicator of organic brain damage. Percept. Mot Skills, 8,

21 Trail making test (A,B) Two versions are available: A, in which the targets are all numbers (1,2,3, etc.), and B, in which the subject alternates between numbers and letters (1, A, 2, B, etc.).

22 Steps of exam performance Step 1: Give the patient a copy of the Trail Making Test Part A worksheet and a pen or pencil. Step 2: Demonstrate the test to the patient using the sample sheet (Trail Making Part A SAMPLE). Step 3: Time the patient as he or she follows the trail made by the numbers on the test. Step 4: Record the time. Step 5: Repeat the procedure for Trail Making Test Part B

23 Tests

24 Scoring Results for both TMT A and B are reported as the number of seconds required to complete the task; therefore, higher scores reveal greater impairment. Trail A: Average 29 seconds, deficiency>78 seconds Trail B: Average 75 seconds, deficiency>273 seconds

25 Clinical dementia rating It is used to quantify the severity of symptoms in dementia The six domains tested were : Memory, Orientation, Judgment and Problem-solving, Community Affairs, Home and Hobbies, and Personal Care. necessary information to make each rating is obtained through a semi-structured interview of the patient and a reliable informant or collateral source (e.g., family member). Morris JC. The Clinical Dementia Rating (CDR): Current version and scoring rules. Neurology 1993; 43:

26 Scoring

27 Clock drawing test-1 A test that can be used as a part of a neurological test or as a assessment tool for Alzheimer's disease and other types of dementia. It is brief and easy to administer The person undergoing testing is asked to; Draw a clock Put in all the numbers Set the hands at ten past eleven.

28 Clock drawing test-2 It may detect deficits in executive functioning that are overlooked by other routine cognitive tests, such as the Mini Mental Status Examination (MMSE).

29 Behave-AD It is a scale for measuring behavioral and psychiatric symptoms in patients with Alzheimer's disease

30 Behave-AD-2 It can measure agitation/anxiety (agitation, anxiety of upcoming events; other anxiety), psychosis (delusions of theft, suspiciousness/paranoia; visual hallucinations), aggression (verbal aggressiveness; physical threats/violence; fear of being left alone; other delusions), depression (tearfulness; depressed mood) and activity disturbance (wandering; delusion one's house is not one's home

31 Neuropsychiatric inventory (NPI) It is used to assess 10 behavioral disturbances occurring in dementia patients such as delusions, hallucinations, dysphoria, anxiety, agitation/aggression, euphoria, disinhibition, irritability/lability, apathy, and aberrant motor activity It examines and scores only those behavioral domains with positive responses to screening questions. Cummings J et al., Neurology 1994

32 Questionnaire (Is it all Greek or Chinese to you?)

33 Apathy assessment

34 MOCA (Montreal Cognitive Assessment) It is a cognitive screening test designed to assist Health Professionals for detection of mild cognitive impairment Nasreddine ZS, et al. The Montreal Cognitive Assessment (MoCA): A Brief Screening Tool For Mild Cognitive Impairment. J Am Geriatr Soc 53: , 2005.

35 MOCA (Montreal Cognitive Assessment)-2

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