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Chan JYC, Kwong JSW, Wong A, Kwok TCY, Tsoi KKF. Comparison of Computerized and Paper-and-Pencil Memory Tests in Detection of Mild Cognitive Impairment and Dementia: A Systematic Review and Meta-analysis of Diagnostic Studies. J Am Med Dir Assoc 2018; 19:748-756.e5. [PMID: 29921507 DOI: 10.1016/j.jamda.2018.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/08/2018] [Accepted: 05/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To compare the diagnostic performance of computerized and paper-and-pencil memory tests in detection of mild cognitive impairment (MCI) and dementia. DESIGN Diagnostic studies comparing computerized or paper-and-pencil memory tests with the standard diagnostic criterion for MCI or dementia were identified from OVID databases. The primary outcome was the diagnostic performance of memory tests for detection of MCI, and detection of dementia was the secondary outcome. Risk of bias and reporting quality in included studies was assessed. SETTING AND PARTICIPANTS Participants with MCI and dementia in any kind of setting. MEASURES Bivariate random-effects models were used to combine the diagnostic performance of memory tests and presented with a summary receiver-operating characteristic curve. RESULTS A total of 58 studies with 18,450 participants with mean age ranging from 55 to 84 years were included. For the verbal memory tests on patients with MCI, computerized tests showed diagnostic accuracy of 0.89 sensitivity (95% confidence interval [CI] 0.69-0.97) and 0.82 specificity (95% CI 0.70-0.90), whereas paper-and-pencil tests showed diagnostic accuracy of 0.86 sensitivity (95% CI 0.82-0.90) and 0.82 specificity (95% CI 0.76-0.86). For the visual memory tests on MCI patients, computerized tests showed diagnostic accuracy of 0.79 sensitivity (95% CI 0.71-0.84) and 0.80 specificity (95% CI 0.71-0.86), whereas paper-and-pencil tests showed diagnostic accuracy of 0.80 sensitivity (95% CI 0.67-0.89) and 0.68 specificity (95% CI 0.51-0.81). The findings were also comparable to those with dementia. CONCLUSIONS/IMPLICATIONS Both verbal and visual computerized memory tests showed comparable diagnostic performance to the paper-and-pencil tests. Computerized cognitive tests show a great potential to use as an alternative to paper-and-pencil tests. When the records can be digitalized, long-term monitoring of cognitive function will be feasible for better management of dementia.
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Affiliation(s)
- Joyce Y C Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Joey S W Kwong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Kelvin K F Tsoi
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong; Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong.
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Neural correlates of episodic memory in the Memento cohort. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 4:224-233. [PMID: 29955665 PMCID: PMC6021546 DOI: 10.1016/j.trci.2018.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction The free and cued selective reminding test is used to identify memory deficits in mild cognitive impairment and demented patients. It allows assessing three processes: encoding, storage, and recollection of verbal episodic memory. Methods We investigated the neural correlates of these three memory processes in a large cohort study. The Memento cohort enrolled 2323 outpatients presenting either with subjective cognitive decline or mild cognitive impairment who underwent cognitive, structural MRI and, for a subset, fluorodeoxyglucose–positron emission tomography evaluations. Results Encoding was associated with a network including parietal and temporal cortices; storage was mainly associated with entorhinal and parahippocampal regions, bilaterally; retrieval was associated with a widespread network encompassing frontal regions. Discussion The neural correlates of episodic memory processes can be assessed in large and standardized cohorts of patients at risk for Alzheimer's disease. Their relation to pathophysiological markers of Alzheimer's disease remains to be studied. This is the largest cohort ever to be used in the study of the morpho-metabolic correlates of episodic memory in human, ensuring the validity of the obtained results. We found that encoding of information is linked to a posterior network previously evidenced to support working memory. The storage process was mainly supported in our study by medial temporal regions. Spontaneous retrieval of stimuli implicated broad neural networks including the frontal regions. These associations were particularly strong in APOE ε4 carriers suggesting that the free and selective reminding test is useful to detect Alzheimer's disease at an early stage.
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Hübner LC, Loureiro F, Tessaro B, Siqueira ECG, Jerônimo GM, Gomes I, Schilling LP. Naming and verbal learning in adults with Alzheimer's disease, mild cognitive impairment and in healthy aging, with low educational levels. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:93-99. [PMID: 29489963 DOI: 10.1590/0004-282x20170190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/21/2017] [Indexed: 06/08/2023]
Abstract
Language assessment seems to be an effective tool to differentiate healthy and cognitively impaired aging groups. This article discusses the impact of educational level on a naming task, on a verbal learning with semantic cues task and on the MMSE in healthy aging adults at three educational levels (very low, low and high) as well as comparing two clinical groups of very low (0-3 years) and low education (4-7 years) patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) with healthy controls. The participants comprised 101 healthy controls, 17 patients with MCI and 19 with AD. Comparisons between the healthy groups showed an education effect on the MMSE, but not on naming and verbal learning. However, the clinical groups were differentiated in both the naming and verbal learning assessment. The results support the assumption that the verbal learning with semantic cues task is a valid tool to diagnose MCI and AD patients, with no influence from education.
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Affiliation(s)
- Lilian Cristine Hübner
- Pontifícia Universidade Católica do Rio Grande do Sul, Departamento de Linguística, Porto Alegre RS, Brasil
- Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
| | - Fernanda Loureiro
- Pontifícia Universidade Católica do Rio Grande do Sul, Instituto de Geriatria e Gerontologia, Porto Alegre RS, Brasil
| | - Bruna Tessaro
- Pontifícia Universidade Católica do Rio Grande do Sul, Departamento de Linguística, Porto Alegre RS, Brasil
| | | | - Gislaine Machado Jerônimo
- Pontifícia Universidade Católica do Rio Grande do Sul, Departamento de Linguística, Porto Alegre RS, Brasil
| | - Irênio Gomes
- Pontifícia Universidade Católica do Rio Grande do Sul, Instituto de Geriatria e Gerontologia, Porto Alegre RS, Brasil
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Grober E, Veroff AE, Lipton RB. Temporal unfolding of declining episodic memory on the Free and Cued Selective Reminding Test in the predementia phase of Alzheimer's disease: Implications for clinical trials. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2018; 10:161-171. [PMID: 29552631 PMCID: PMC5852329 DOI: 10.1016/j.dadm.2017.12.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction Free and Cued Selective Reminding Test (FCSRT) performance identifies patients with preclinical disease at elevated risk for developing Alzheimer's dementia, predicting diagnosis better than other memory tests. Methods Based on literature mapping FCSRT performance to clinical outcomes and biological markers, and on longitudinal preclinical data from the Baltimore Longitudinal Study of Aging, we developed the Stages of Objective Memory Impairment (SOMI) model. Five sequential stages of episodic memory decline are defined by Free Recall (FR) and Total Recall (TR) score ranges and years prior to dementia diagnosis. We sought to replicate the SOMI model using longitudinal assessments of 142 Einstein Aging Study participants who developed AD over 10 years. Results Time to diagnosis was at least seven years if FR was intact, at least four years if TR was intact, and two years if TR was impaired, consistent with SOMI model predictions. The SOMI identified incipient dementia with excellent sensitivity and specificity. Discussion The SOMI model provides an efficient approach for clinical trial cognitive screening in advance of more costly biomarker studies and ultimately in clinical practice, and provides a vocabulary for understanding AD biomarker patterns and for re-analysis of existing clinical trial data.
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Affiliation(s)
- Ellen Grober
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | | | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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Levy Nogueira M, Samri D, Epelbaum S, Lista S, Suppa P, Spies L, Hampel H, Dubois B, Teichmann M. Alzheimer's Disease Diagnosis Relies on a Twofold Clinical-Biological Algorithm: Three Memory Clinic Case Reports. J Alzheimers Dis 2017; 60:577-583. [PMID: 28869481 DOI: 10.3233/jad-170574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The International Working Group recently provided revised criteria of Alzheimer's disease (AD) proposing that the diagnosis of typical amnesic AD should be established by a clinical-biological signature, defined by the phenotype of an "amnesic syndrome of the hippocampal type" (ASHT) combined with positive in vivo evidence of AD pathophysiology in the cerebrospinal fluid (CSF) or on amyloid PET imaging. The application and clinical value of this refined diagnostic algorithm, initially intended for research purposes, is explored in three memory clinic cases presenting with different cognitive profiles including an ASHT, hippocampal atrophy, and CSF AD-biomarker data. The case reports highlight that the isolated occurrence of one of the two proposed AD criteria, ASHT or positive pathophysiological markers, does not provide a reliable diagnosis of typical AD. It is proposed that the twofold diagnostic IWG algorithm can be applied and operationalized in memory clinic settings to improve the diagnostic accuracy of typical amnesic AD in clinical practice.
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Affiliation(s)
- Marcel Levy Nogueira
- Department of Neurology, Institute of Memory and Alzheimer's Disease, Pitié-Salpêtrière University Hospital, Paris, France
| | - Dalila Samri
- Department of Neurology, Institute of Memory and Alzheimer's Disease, Pitié-Salpêtrière University Hospital, Paris, France
| | - Stéphane Epelbaum
- Department of Neurology, Institute of Memory and Alzheimer's Disease, Pitié-Salpêtrière University Hospital, Paris, France
| | | | - Per Suppa
- Department of Nuclear Medicine, Charité, Berlin, Germany.,Jung diagnostics GmbH, Hamburg, Germany
| | | | - Harald Hampel
- Department of Neurology, Institute of Memory and Alzheimer's Disease, Pitié-Salpêtrière University Hospital, Paris, France.,AXA Research Fund and UPMC Chair, Paris, France
| | - Bruno Dubois
- Department of Neurology, Institute of Memory and Alzheimer's Disease, Pitié-Salpêtrière University Hospital, Paris, France.,Department of Neurology, Institute of Memory and Alzheimer's Disease, National Reference Center for Rare Dementias, Pitié Salpêtrière University Hospital, Paris, France.,Brain and Spine Institute (ICM) - INSERM 1127, Frontlab, Paris, France
| | - Marc Teichmann
- Department of Neurology, Institute of Memory and Alzheimer's Disease, Pitié-Salpêtrière University Hospital, Paris, France.,Department of Neurology, Institute of Memory and Alzheimer's Disease, National Reference Center for Rare Dementias, Pitié Salpêtrière University Hospital, Paris, France.,Brain and Spine Institute (ICM) - INSERM 1127, Frontlab, Paris, France
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