A PRELIMINARY STUDY OF SIX EVALUATION INSTRUMENTS IN OLDER PERSONS WITH SUBJECTIVE COGNITIVE IMPAIRMENT

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1 A PRELIMINARY STUDY OF SIX EVALUATION INSTRUMENTS IN OLDER PERSONS WITH SUBJECTIVE COGNITIVE IMPAIRMENT Francoise Guillo-Benarous, M.D. Geriatrician, Faculty Research Clinician New York University School of Medicine Alzheimer s Disease Research Center 145 East 32 nd street New York NY Francoise.benarous@nyumc.org

2 BACKGROUND

3 Source : ADI World Alzheimer Report 2013

4 SCI : SUBJECTIVE COGNITIVE IMPAIRMENT SUBJECTIVE DEFICIT AND MEMORY COMPLAINT : WHAT ARE THE SYMPTOMS? A PRE MILD COGNITIVE IMPAIRMENT STAGE? A PREDICTOR OF FUTURE COGNITIVE DECLINE? GLOBAL DETERIORATION SCALE GDS 2 NCI VERSUS SCI WHAT IS SCI?

5 NCI SCI MCI AD

6 NCI SCI NCI MCI SCI NCI AD

7 Source : NIH State of the Science Conference 4/28/2010 Bethesda, Maryland

8 Bateman RJ et al. N Engl J Med 2012; 367:

9 Cross-Sectional Analyses of Clinical, Cognitive, Structural, Metabolic, and Biochemical Changes in Autosomal Dominant Alzheimer's Disease Mutation Carriers versus Noncarriers, According to Estimated Years from Expected Symptom Onset. Randall J. Bateman, M.D., Chengjie Xiong, Ph.D., Tammie L.S. Benzinger, M.D., Ph.D., Anne M. Fagan, Ph.D., Bateman RJ et al. N Engl J Med 2012;367:

10 AIMS

11 AIMS OF THE RESEARCH PROJECT 1-TO DESCRIBE AND TO RECOGNIZE POTENTIAL EARLIEST SYMPTOMS OF AD (and answer the question What are the relationships between subjective symptoms of cognitive decline and cognitive decline in AD?) -Risk factors? -Authentic symptoms? -Do we have to look for specificity? -Which is the time relationship between subjective symptoms and anatomical changes? -Can we find correlations with early neuro-imaging findings? 2-TO CHOOSE THE OPTIMAL TIME TO INITIATE PREVENTIVE STRATEGIES - And define the domain of preventives studies

12 GOALS OF THE STUDY 1-TO ASSESS THE COGNITIVE AND BEHAVIORAL, PRE-MILD COGNITIVE IMPAIRMENT (MCI) SYNDROME 2-TO COMPARE DIFFERENT ASSESSMENT INSTRUMENTS 3-TO ELABORATE A COST EFFECTIVE METHOD FOR LARGE STUDIES

13 METHOD

14 YEARLY FOLLOWED SUBJECTS AT THE NEW YORK UNIVERSITY ALZHEIMER S DISEASE RESEARCH CENTER, HAVE BEENASKED TO RATE THEIR SUBJECTIVE SYMPTOMS THROUGH SELF - REPORTED QUESTIONNAIRES : -VISUAL ANALOG GLOBAL SCALE -TIME RELATED QUESTIONNAIRES -SEVERITY BASED QUESTIONNAIRES SELF REPORTED QUESTIONNAIRES

15 The Brief Questionnaire Regarding Severity of Memory & Emotional Problems (BQRS-M&E), (Reisberg, 2013). This is a 5 item scale derived from previous research findings. The ADNI scale developed by Dr. Saykin, modified as a severity scale, rather than a temporally based scale (Saykin, Reisberg modification, 2013). Emotional Severity Scale (ESS), (Guillo Benarous, 2013). A 20 item questionnaire assessing behavioral and mood changes. SEVERITY BASED QUESTIONNAIRES

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18 (ADNI) consortium Self Report Index Self- Report Index, a scale based upon a comparison with subjective symptoms five years previously (Saykin, version ) The Sahlgrenska Academy Self-reported Cognitive Impairment Questionnaire (SASCI-Q), a scale published in 2012, part 2 compares the present symptoms with symptoms 10 and 25 years previously; (Eckerstro m, et al., Int Psychogeriatr, 2012 ) TEMPORAL ASSESSMENT BASED SCALES

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20 MAGNITUDE OF SUBJECTIVE COGNITIVE IMPAIRMENT ASSESSED ON A TEN POINTS SCALE. VISUAL ANALOG SCALE

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22 INCLUSION CRITERIA Healthy subjects Subjects with SCI, stage 2 on the Global Deterioration Scale, (N = 34), presenting for evaluations at the NYU Alzheimer s Disease Center and 1. Complaining of cognitive impairment 2. Subjects must be 50 years of age or greater 3. Willing to participate in the study 4. Each subject must have results of clinical laboratory tests (complete blood count [CBC], blood chemistries, thyroid stimulating hormone [TSH], serum B12, and serum folate), within normal limits or clinically acceptable to the investigator at the first visit. 5. Each subject must have results of a physical examination, vital signs, and an electrocardiogram within normal limits or clinically acceptable to the investigator at the first visit.

23 VISUAL SCALE+BRIEF QUESTIONNAIRE EVEN ODD SEVCOG EMOTIONAL SCALE ADNI SELF REPORT SASCI-Q

24 SCORES STATISTICAL REGRESSION MODEL ANALYSIS RESULTS

25 N=34 (N=94) FEMALES 68% 71.3% MALES 32% 29.7% MC 14.8% MEAN SD MEDIAN RANGE AGE 72, / /_ EDUCATION 16, / / POPULATION

26 N=94 MEAN SD MEDIAN RANGE Visual Analog Scale (1-10) BRIEF (1-7) ADNI (1-7) SEVCOG (1-5) EMOT (1-7) SASCI-Q ( ) SCORES REPARTITION

27 Visual Analog Scale S1 Brief S2 ADNI S3 Sev Cog S4 Emot S5 SASCI-Q AGE NS p=0.41 p=0.03 NS p=0.86 p=0.05 p=0.03 NS p=0.24 NS p=0.25 p=0.003 NS p=0.45 p=0.011 p=0.10 NS p=0.76 EDUC NS p=0.77 NS p=0.79 NS p=0.90 NS p=0.85 NS p=0.08 NS p=0.16 NS p=0.87 NS p=0.61 NS p=0.72 NS p=0.46 NS p=0.13 NS p=0.37 CORRELATIONS

28 N=34 N=94 S1 Brief S2 ADNI S3 Sev cog S4 Emot. S5 SASCI-Q VisualAnalogScale p< p<0.01 p< p< NS p< p<0.01 p< p=0.001 p< CORRELATIONS INTER-SCALES

29 THE SELF RATED SEVERITY OF COGNITIVE CHANGES/MEMORY IS A MORE RELEVANT ELEMENT THAN SCORES ON TIME RELATED SCALES VAS COULD BE A REMARQUABLE AND SIMPLE INSTRUMENT TO ASSESS THE SEVERITY THE VAS IS NOT INFLUENCED BY AGE OR EDUCATION LEVEL (CULTURAL BACKGROUND?) CONCLUSION

30 The factor Age, a strong risk factor for SCI, MCI, and AD is captured by severity and emotional self-rated scales in SCI persons. The scales based on retrospective temporal comparators did not show significant relationships to age. Further comparative and longitudinal studies will better define the advantages of diverse approaches to SCI assessment as prognostic markers of future decline.

31 EVOLUTION OF SCORES OVER TIME CORRELATIONS BETWEEN PSYCHOMETRIC TESTING AND SUBJECTIVES STUDIES CORRELATIONS WITH NEURO ANATOMICAL CHANGES, NEUROIMAGING AND /OR NEW BIOMARKERS FURTHER DEVELOPEMENTS

32 YEAR 1 SUBJECTIVE EVALUATION PSYCHOMETRIC TESTING BIOMARKERS IMAGING YEAR 2 SUBJECTIVE EVALUATION PSYCHOMETRIC TESTING YEAR 3 SUBJECTIVE EVALUATION PSYCHOMETRIC TESTING BIOMARKERS IMAGING

33 THANK YOU! IMAGE : WALLY CARUANA. ABORIGINAL ART. THAMES & HUDSON

34 Conflict of Interest Disclosure Francoise Guillo-Benarous, M.D. Conflict with: New York University Langone Medical Center Conflict with: Clinical Researcher Development Fund of the New York University School of Medicine Conflict with: I am the developer of some of the measures described in this abstract. A. Vengassery: None DeclaredC. Torossian Conflict with: New York University Langone Medical CenterS. Ghimire: None DeclaredJ. Xu Conflict with: New York University School of MedicineB. Reisberg Conflict with: New York University School of Medicine Conflict with: US National Institute on Aging, National Institutes of Health, The Stringer Foundation, The Louis J Kay and June E Kay Foundation, The Hagedorn Fund, The Fisher Center for Alzheimer's Research Foundation, Conflict with: I am the developer of some of the measures described in this abstract. Has no real or apparent conflicts of interest to report.

35 NYULMC ALZHEIMER S DISEASE RESEARCH CENTER (NYUADC) NEW YORK UNIVERSITY SCHOOL OF MEDICINE Barry Reisberg, M.D. Aninditha Vengassery, M.D. Xu Jinfeng, Ph.D. Carol Torossian, Psy.D. Santosh Ghimire, M.D. Thet Oo, M.D, Milena Perez, coordinators ACKNOWLEDGEMENTS