Graphic skills used as an instrument for detecting higher cortical dysfunctions in old age

Screening for Alzheimer's dementia at age 78 with short psychometric instruments

BACKGROUND

To date, no single instrument has proved to be adequate for screening for Alzheimer's dementia (AD). The aim of this study was to identify a combination of instruments which were highly sensitive for screening late onset AD.

METHODS

Subjects were drawn from the Vienna TransDanube Aging (VITA) study. This is an interdisciplinary, longitudinal community-based cohort study of the 21st and 22nd district of Vienna (Austria). Data refer to the cohort of 478 individuals at age 78 who took part in the first follow-up investigation of the VITA study. The psychometric instruments which were investigated were: the Ten-Point Clock Test, the Human-Figure Drawing Test, a Delayed Selective Reminding Test, Naming, the Trail Making Test-B, and Verbal Fluency. Further instruments were the Pocket Smell Test, and Subjective Memory Complaints. Data were analyzed using logistic regression analyses and cross validation.

RESULTS

A combination of the Delayed Selective Reminding Test and Verbal Fluency was best for screening AD (R2 = 0.38, main model). An area under the ROC curve of 0.829 was reached. This model discriminated between subjects with incident AD and subjects who did not have incident AD with a sensitivity of 91% and a specificity of 56%.

CONCLUSION

The combination of an episodic memory test and a test of verbal fluency was an effective way of screening for AD.

Assessing the handwriting process in healthy elderly persons using a computerized system

BACKGROUND AND AIMS

Despite the importance of handwriting in everyday life, virtually no literature can be found documenting the extent and range of everyday handwriting performance and ability among healthy elderly persons. The aim of this pilot study was to examine the kinematic characteristics of the handwriting process of healthy elderly persons and its correlates.

METHODS

Fifty-three healthy participants (aged 60 to 94) living in the community, performed five functional writing tasks using a computerized system which documented the handwriting process.

RESULTS

In air time (i.e., the time of non-writing while writing) accounted for approximately half to two-thirds of total writing time. Higher age was consistently associated with longer on paper and in air time, as well as with lower speed and lower pressure.

CONCLUSIONS

The results of this pilot study indicate that kinematic analysis of handwriting provides important information about the handwriting process among elderly people.

Vienna Transdanube Aging "VITA": study design, recruitment strategies and level of participation

The Vienna Transdanube Aging study "VITA" is a prospective, interdisciplinary cohort-study of all 75-years old inhabitants of the 21. and 22. district of Vienna (n = 1,745), which started in May 2000. The study design is described in this paper for the first time. The main scientific question of the study concerns the prediction of incident dementia in the elderly. The main statistical analysis will compare 8 predictors: episodic memory, verbal fluency, subjective memory complaints, depression, APOE-epsilon4, MAO-B activity in thrombocytes, MRT hippocampal atrophy, and MRT atrophy of the substantia innominata. The whole investigation comprises medical and psychosocial interviews, psychological tests, psychiatric and neurological scales, blood characteristic, genetic factors and cranial magnetic resonance imaging. Various variables will be compared with each other concerning sensitivity and specificity of prediction of cognitive decline. The dependent variable of the intended statistical analysis will be the individual's difference between Mini Mental State Examination scores at the two times of investigation. A high level of participation in geriatric epidemiological studies increases the general applicability of results but recruitment procedures must not ignore the individual's right to privacy and integrity. Using a liberal recruitment procedure as recommended by the local ethics commission the level of participation is between 36.7% and 44.3%.

Human-figure drawing (HFD) in the screening of cognitive impairment in old age

OBJECTIVE

The aim of the study is to test the hypothesis that freehand human-figure drawing (HFD), can be used as a complementary screening instrument to differentiate between demented elderly people and healthy elderly controls in population based studies.

METHOD

HFD was examined in 668 elderly ( > or = 75 years of age) participants from an epidemiological study in Stockholm, who were asked to draw a human figure. The drawings were analysed on the content of body details and structural characteristics.

RESULT

The results show quite clearly that the body details and the height decrease with decreasing cognitive function, whereas the centredness (the distance in cm from the centre of the figure to the centre of the paper) increases with decreasing cognitive functioning. Demented people place their figures in the upper left corner of the sheet, compared with the mostly well centred figures of non-demented people. Age, on the other hand, has an influence on the HFD as after 90 years of age most of the variables show regressive changes.

CONCLUSION

The HFD can help to differentiate between demented and non-demented subjects as well as between dementia of different severity. The HFD does not help us, however, to discriminate between Alzheimer's disease and vascular dementia. Age has an influence on the HFD in the sense that after 90 years most of the variables regress to a smaller or more primitive form.

Copying and handwriting ability in the screening of cognitive dysfunction in old age

Geometric copying and handwriting tests are often assessed in the screening of cognitive deficiency in the elderly. The aim of the study was to show the regression of geometrical copying and handwriting with increasing cognitive impairment in old age. The study is population-based and includes 668 subjects aged 75 years and older, living in an inner-city area of Stockholm. The subjects were asked to copy a cube, two pentagons, a rhombus, two intersecting rectangles, and a circle. They were also asked to write a complete sentence spontaneously, a sentence from dictation and their name. Geometric copying and handwriting skills decreased in direct proportion to decreased cognitive functioning. The skills most sensitive to small changes in cognition were copying the cube and the pentagons. Other skills were less sensitive to small changes: writing a complete sentence, copying a rhombus, two rectangles and writing one's name. However, copying and handwriting appear to complement each other. Copying of the rectangles and rhombus is more useful than the other figures because these two can be discriminated throughout different stages of dementia. Sentence writing from dictation and signature can be used to evaluate severely impaired subjects because these skills seem to be retained longer than the spontaneous sentence writing.

Unexpected dental behavior in five Alzheimer patients. Differences between cognitive and functional capacity, graphic performance, and dental behavior

The aim of the study was to analyze five patients with Alzheimer's disease in whom the degree of dementia assessed by cognitive and functional tests was at variance with the behavior in the dental setting and to relate these factors to the outcome of the graphic test. Possible reasons for the differences were discussed. The subjects were diagnosed as having Alzheimer's dementia on the basis of the DSM-III-R. Their cognitive and functional impairments were assessed with the Mini-Mental State Examination test and Katz's index of activities of daily living. Behavior in the dental office was registered in a structured form. The graphic function was assessed as Human Figure Drawing. Besides the stage of dementia, the patient's personality, social and medical background, and memories of previous dental care influence the demented patient's behavior in the dental office. To provide secure conditions for treating demented patients, the dentist must be able to interpret the patient's unique personality in the context of the dental situation.

The short human figure drawing scale for evaluation of suspect cognitive dysfunction in old age

Human figure drawings have been widely used to assess cognitive development in children. In the present study, free-hand human figure drawings were examined for 62 demented patients, and 60 normal elderly subjects. The drawings were scored for 53 body details using a method derived from work with children. A short scale of 15 details was developed by selecting body details with high item-total correlations which are simple to score even for untrained staff. This short scale had excellent interscorer and test-retest reliability and excellent concurrent validity as well. It correlated highly with the Mini-Mental State Examination, a commonly used screening test for dementia. The short scale discriminated demented and non-demented subjects and different levels of dementia severity as graded by the Clinical Dementia Rating Scale. However, no differences were observed between Alzheimer patients and patients with vascular dementia concerning presence of details in human figure drawings.