Diagnostic accuracy of percent retention scores on RBANS verbal memory subtests for the diagnosis of Alzheimer's disease and mild cognitive impairment

Recall and recognition subtests of the repeatable battery for the assessment of neuropsychological status and their relationship to biomarkers of Alzheimer's disease

Recently, two new recognition subtests for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were developed and initially validated in a cohort of older adults who were cognitively intact or classified as amnestic Mild Cognitive Impairment (MCI) or mild Alzheimer's disease (AD). The current paper extends that validation by comparing the recall and recognition subtests of the RBANS, including the existing and recently developed scores, to three commonly used biomarkers in AD in an expanded sample from the initial validation. One hundred fifty-four older adults (65 intact, 46 MCI, 43 AD) were administered the RBANS, which included the recently developed subtests for Story Recognition and Figure Recognition (hits, false positives, total correct), as part of a study on memory and biomarkers. Participants also completed magnetic resonance imaging to obtain hippocampal volumes, positron emission tomography to obtain amyloid plaque deposition, and a blood draw to obtain APOE ε4 status. Whereas correlations between recall scores and biomarkers tended to be moderate (average r = ±0.48), these correlations were comparable across the three recognition total scores (average r = ±0.42), but tended to be lower for recognition hits (average r = ±0.28) and false positives (average r = ±0.38). These results further validate the existing and recently developed recognition scores on the RBANS as providing useful information about brain and genetic pathology in older adults with intact and impaired cognitive functioning.

Change on the Repeatable Battery for the Assessment of Neuropsychological Status and its relationship to brain amyloid

BACKGROUND

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been associated with commonly used biomarkers of Alzheimer's disease (AD), including brain amyloid plaque density. However, less is known about if changes in the RBANS across time are also related to brain amyloid deposition. The current study sought to expand on prior work by examining the relationship between changes over time on the RBANS and amyloid deposition via positron emission tomography (PET).

METHOD

One-hundred twenty-six older adults with intact or impaired cognition and daily functioning underwent repeat assessment with the RBANS across nearly 16 months, as well as had a baseline amyloid PET scan.

RESULTS

In the entire sample, amyloid deposition was significantly related to change on all five Indexes and the Total Scale score of the RBANS, with greater amyloid being associated with worsening cognition. This pattern was also observed in 11 of 12 subtests.

CONCLUSIONS

Whereas prior studies have identified a relationship between baseline RBANS and amyloid status, the current findings support that changes in the RBANS are also indicative of AD brain pathology, even if these findings are mediated by cognitive status. Although replication in a more diverse sample is needed, these results continue to support the use of the RBANS in AD clinical trials.

Repeatable battery for the assessment of neuropsychological status and its relationship to biomarkers of Alzheimer's disease

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been associated with commonly used biomarkers of Alzheimer's disease (AD). However, prior studies have typically utilized small and poorly characterized samples, and they have not analyzed the subtests of the RBANS. The current study sought to expand on prior work by examining the relationship between the Indexes and subtest scores of the RBANS and three AD biomarkers: amyloid deposition via positron emission tomography, hippocampal volume via magnetic resonance imaging, and APOE ε4 status.

One-hundred twenty-one older adults across the AD continuum (intact, amnestic Mild Cognitive Impairment, mild AD), who were mostly Caucasian and well-educated, underwent assessment with the RBANS and collection of the three biomarkers.

Greater amyloid deposition was significantly related to lower scores on all five Indexes and the Total Scale score of the RBANS, as well as 11 of 12 subtests. For bilateral hippocampal volume, significant correlations were observed for 4 of the 5 Indexes, Total Scale score, and 9 of 12 subtests, with smaller hippocampi being related to lower RBANS scores. Participants with at least one APOE ε4 allele had significantly lower scores on 3 of the 5 Indexes, Total Scale score, and 8 of the 12 subtests.

In this sample of participants across the dementia spectrum, most RBANS Indexes and subtests showed relationships with the amyloid deposition, hippocampal volumes, and APOE status, with poorer performance on the RBANS being associated with biomarker positivity. Although memory scores on the RBANS have traditionally been linked to biomarkers in AD, other Index and subtest scores also hold promise as indicators of AD. Replication in a more diverse sample is needed.

Predicting biomarkers in intact older adults and those with amnestic Mild Cognitive Impairment, and mild Alzheimer's Disease using the Repeatable Battery for the Assessment of Neuropsychological Status

INTRODUCTION

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been associated, to varying degrees, with commonly used biomarkers of Alzheimer's disease (AD). Given the ease of RBANS administration as a screening tool for clinical trials and other applications, a better understanding of how RBANS performance is associated with presence of APOE ε4 allele[s], cerebral amyloid burden, and hippocampal volume is warranted.

METHOD

One hundred twenty-one older adults who were classified as intact, amnestic Mild Cognitive Impairment, or mild AD underwent cognitive assessment with the RBANS, genetic analysis, and quantitative brain imaging. APOE ε4 carrier status, 18F-Flutemetamol composite standardized uptake value ratio (SUVR), and hippocampal volume were each regressed on demographic variables and RBANS Total Scale score, Index scores, and subtest scores.

RESULTS

Lower RBANS Total Scale score or Delayed Memory Index (DMI) predicted the presence of APOE ε4 allele[s], higher cerebral amyloid burden, and lower hippocampal volumes. DMI was a slightly better predictor than Total Scale score for most AD biomarkers. No demographic variables consistently contributed to these models.

CONCLUSIONS

The RBANS - DMI in particular - is sensitive to AD pathology. As such, it could be used as a predictive tool, particularly in clinical drug trials to enrich samples prior to less accessible AD biomarker investigation.

Electroconvulsive Therapy Pulse Amplitude and Clinical Outcomes

INTRODUCTION

Electroconvulsive therapy (ECT) pulse amplitude, which determines the induced electric field magnitude in the brain, is currently set at 800-900 milliamperes (mA) on modern ECT devices without any clinical or scientific rationale. The present study assessed differences in depression and cognitive outcomes for three different pulse amplitudes during an acute ECT series. We hypothesized that the lower amplitudes would maintain the antidepressant efficacy of the standard treatment and reduce the risk of neurocognitive impairment.

METHODS

This double-blind investigation randomized subjects to three treatment arms: 600, 700, and 800 mA (active comparator). Clinical, cognitive, and imaging assessments were conducted pre-, mid- and post-ECT. Subjects had a diagnosis of major depressive disorder, age range between 50 and 80 years, and met clinical indication for ECT.

RESULTS

The 700 and 800 mA arms had improvement in depression outcomes relative to the 600 mA arm. The amplitude groups showed no differences in the primary cognitive outcome variable, the Hopkins Verbal Learning Test-Revised (HVLT-R) retention raw score. However, secondary cognitive outcomes such as the Delis Kaplan Executive Function System Letter and Category Fluency measures demonstrated cognitive impairment in the 800 mA arm.

DISCUSSION

The results demonstrated a dissociation of depression (higher amplitudes better) and cognitive (lower amplitudes better) related outcomes. Future work is warranted to elucidate the relationship between amplitude, electric field, neuroplasticity, and clinical outcomes.

Brief Cognitive Tests for Distinguishing Clinical Alzheimer-Type Dementia From Mild Cognitive Impairment or Normal Cognition in Older Adults With Suspected Cognitive Impairment

BACKGROUND

The accuracy and harms of brief cognitive tests for identifying clinical Alzheimer-type dementia (CATD) are uncertain.

PURPOSE

To summarize evidence on accuracy and harms of brief cognitive tests for CATD in older adults with suspected cognitive impairment.

DATA SOURCES

Electronic bibliographic databases (from inception to November 2019) and systematic review bibliographies.

STUDY SELECTION

English-language, controlled observational studies in older adults that evaluated the accuracy of brief cognitive tests (standalone tests; memory, executive function, and language tests; and brief multidomain batteries) for distinguishing CATD from mild cognitive impairment (MCI) or normal cognition as defined by established diagnostic criteria. Studies with low or medium risk of bias (ROB) were analyzed.

DATA EXTRACTION

Two reviewers rated ROB. One reviewer extracted data; the other verified extraction accuracy.

DATA SYNTHESIS

Fifty-seven studies met analysis criteria. Many brief, single cognitive tests were highly sensitive and specific for distinguishing CATD from normal cognition. These included standalone tests (clock-drawing test, median sensitivity 0.79 and specificity 0.88 [8 studies]; Mini-Mental State Examination, 0.88 and 0.94 [7 studies]; Montreal Cognitive Assessment, 0.94 and 0.94 [2 studies]; and Brief Alzheimer Screen, 0.92 and 0.97 [1 study]), memory tests (list delayed recall, 0.89 and 0.94 [5 studies]), and language tests (category fluency, 0.92 and 0.89 [9 studies]). Accuracy was lower in distinguishing mild CATD from normal cognition and distinguishing CATD from MCI. No studies reported on testing harms.

LIMITATIONS

Studies were small. Few test metrics were evaluated by multiple studies. Few studies directly compared different tests, scores, cut points, or test combinations.

CONCLUSION

Many brief, single cognitive tests accurately distinguish CATD from normal cognition in older adults but are less accurate in distinguishing mild CATD from normal cognition or CATD from MCI. No studies reported on testing harms.

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality. (PROSPERO: CRD42018117897).

Electroconvulsive therapy treatment responsive multimodal brain networks

Electroconvulsive therapy is regarded as the most effective antidepressant treatment for severe and treatment-resistant depressive episodes. Despite the efficacy of electroconvulsive therapy, the neurobiological underpinnings and mechanisms underlying electroconvulsive therapy induced antidepressant effects remain unclear. The objective of this investigation was to identify electroconvulsive therapy treatment responsive multimodal biomarkers with the 17-item Hamilton Depression Rating Scale guided brain structure-function fusion in 118 patients with depressive episodes and 60 healthy controls. Results show that reduced fractional amplitude of low frequency fluctuations in the prefrontal cortex, insula and hippocampus, linked with increased gray matter volume in anterior cingulate, medial temporal cortex, insula, thalamus, caudate and hippocampus represent electroconvulsive therapy responsive covarying functional and structural brain networks. In addition, relative to nonresponders, responder-specific electroconvulsive therapy related brain networks occur in frontal-limbic network and are associated with successful therapeutic outcomes. Finally, electroconvulsive therapy responsive brain networks were unrelated to verbal declarative memory. Using a data-driven, supervised-learning method, we demonstrated that electroconvulsive therapy produces a remodeling of brain functional and structural covariance that was unique to antidepressant symptom response, but not linked to memory impairment.

Normative Data for Derived Measures and Discrepancy Scores for the Uniform Data Set 3.0 Neuropsychological Battery

OBJECTIVE

The Uniform Data Set 3.0 (UDS 3.0) neuropsychological battery is a recently published battery intended for clinical research with older adult populations. While normative data for the core measures has been published, several additional discrepancy and derived scores can also be calculated. We present normative data for Trail Making Test (TMT) A & B discrepancy and ratio scores, semantic and phonemic fluency discrepancy scores, Craft Story percent retention score, Benson Figure percent retention score, difference between verbal and visual percent retention, and an error index.

METHOD

Cross-Sectional data from 1803 English speaking, cognitively normal control participants were obtained from the NACC central data repository.

RESULTS

Descriptive information for derived indices is presented. Demographic variables, most commonly age, demonstrated small but significant associations with the measures. Regression values were used to create a normative calculator, made available in a downloadable supplement. Statistically abnormal values (i.e., raw scores corresponding to the 5th, 10th, 90th, and 95th percentiles) were calculated to assist in practical application of normative findings to individual cases. Preliminary validity of the indices are demonstrated by a case study and group comparisons between a sample of individuals with Alzheimer's (N = 81) and Dementia with Lewy Bodies (DLB; N = 100).

CONCLUSIONS

Clinically useful normative data of such derived indices from the UDS 3.0 neuropsychological battery are presented to help researchers and clinicians interpret these scores, accounting for demographic factors. Preliminary validity data is presented as well along with limitations and future directions.

The repeatable battery for the assessment of the neuropsychological status (RBANS): a diagnostic validity study in Greek elderly

OBJECTIVE

There is a broad need for a rapid and efficient neurocognitive battery to detect cognitive decline and differentiate MCI (mild cognitive impairment) and mild dementia from cognitively intact elders. The purpose of this study is to create a version of the repeatable battery for the assessment of neuropsychological status (RBANS) for the Greek population.

METHOD

One hundred and sixty-three (163) adults, including healthy controls (HC), MCI and patients with mild dementia, irrespective etiology, were recruited from the day centers of Greek Alzheimer Association after having followed the diagnostic procedure set by the DSM V. The three groups of our sample were matched for age, gender, and education.

RESULTS

The Greek RBANS had satisfactory internal reliability, as it yielded the satisfactory coefficient of 0.914. According to the criterion validity, the sensitivity of the RBANS Total score to discriminate controls from patients with mild dementia was 0.94, whereas the specificity was 0.97. In addition, RBANS was also able to discriminate HC from MCI population (sensitivity = 0.87, specificity = 0.81) and MCI from patients with mild dementia (sensitivity = 0.91, specificity = 0.97).

CONCLUSIONS

The current data suggest that the Greek version of RBANS is both a valid and reliable psychometric tool, as well as sensitive for detecting cognitive impairment in MCI and early dementia, irrespective etiology. Therefore, taken into account that it revealed coherence in discriminating HC from clinical population, it should be utilized as a neuropsychological screening battery in Greek elders in clinical practice, and also in research protocols.

Robotic technology provides objective and quantifiable metrics of neurocognitive functioning in survivors of critical illness:A feasibility study

PURPOSE

To assess the feasibility of using an integrated multimodal data collection strategy to characterize the post-intensive care syndrome (PICS).

MATERIALS AND METHODS

Adult patients admitted to the ICU requiring invasive mechanical ventilation for >24 h and/or requiring vasopressor support were eligible for enrollment. We assessed cognitive and sensorimotor function at 3- and 12-months after ICU discharge with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and with the KINARM robot.

RESULTS

At 3- and 12-months after ICU discharge, 28/70 (40%) and 22/70 (31%) returned for follow-up testing, respectively. Prominent reasons for declining testing at 3- and 12-months included: not interested (40% and 38%) and health complications (31% and 31%). The majority of returning participants completed all tasks (96%-100%) and 100% of available data was recorded. On the RBANS, 54% (3 months) and 32% (12 months) of individuals were impaired in visuospatial/constructional skills. Similarly, the KINARM assessments demonstrated that 56% of individuals had visuospatial/executive dysfunction at 3 months, and 40% had impairment at 12 months. Individual scores indicated substantial variability.

CONCLUSIONS

We demonstrated that it was feasible to quantify neurological dysfunction among participants that returned for follow-up testing. However, future investigations will need to implement multiple retention strategies.

TRIAL REGISTRATION

This trial is registered on clinicaltrials.gov (Identifier: NCT02344043), retrospectively registered January 8, 2015.

Diagnostic Accuracy of Memory Measures in Alzheimer's Dementia and Mild Cognitive Impairment: a Systematic Review and Meta-Analysis

With an increasing focus on biomarkers in dementia research, illustrating the role of neuropsychological assessment in detecting mild cognitive impairment (MCI) and Alzheimer's dementia (AD) is important. This systematic review and meta-analysis, conducted in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) standards, summarizes the sensitivity and specificity of memory measures in individuals with MCI and AD. Both meta-analytic and qualitative examination of AD versus healthy control (HC) studies (n = 47) revealed generally high sensitivity and specificity (≥ 80% for AD comparisons) for measures of immediate (sensitivity = 87%, specificity = 88%) and delayed memory (sensitivity = 89%, specificity = 89%), especially those involving word-list recall. Examination of MCI versus HC studies (n = 38) revealed generally lower diagnostic accuracy for both immediate (sensitivity = 72%, specificity = 81%) and delayed memory (sensitivity = 75%, specificity = 81%). Measures that differentiated AD from other conditions (n = 10 studies) yielded mixed results, with generally high sensitivity in the context of low or variable specificity. Results confirm that memory measures have high diagnostic accuracy for identification of AD, are promising but require further refinement for identification of MCI, and provide support for ongoing investigation of neuropsychological assessment as a cognitive biomarker of preclinical AD. Emphasizing diagnostic test accuracy statistics over null hypothesis testing in future studies will promote the ongoing use of neuropsychological tests as Alzheimer's disease research and clinical criteria increasingly rely upon cerebrospinal fluid (CSF) and neuroimaging biomarkers.

RBANS memory percentage retention: No evidence of incremental validity beyond RBANS scores for diagnostic classification of mild cognitive impairment and dementia and for prediction of daily function

RBANS percentage retention scores may be useful for diagnosis, but their incremental validity is unclear. Percentage retention versus RBANS immediate and delayed memory subtests and delayed index scores were compared for diagnostic classification and for prediction of function. Data from 173 memory clinic patients with an interdisciplinary diagnosis (no cognitive impairment, amnestic mild cognitive impairment [aMCI], and dementia due to Alzheimer's disease [AD]) and complete RBANS data were analyzed. Across diagnostic contrasts, list percentage retention classification accuracy was similar to List Learning delayed recall, but below the Delayed Memory Index (DMI). Similarly, for classifying no cognitive impairment versus aMCI or dementia due to AD, story percentage retention was similar to Story Memory subtests and below the DMI. For classifying aMCI versus AD; however, Story Memory exceeded the DMI, but was similar to Story Memory subtest scores. Similarly, for prediction of function percentage retention measures did not predict variance beyond that predicted by the RBANS subtest or index scores. In sum, there is no evidence that calculation of percentage retention for RBANS adds clinical utility beyond those provided by the standard RBANS scores.

Relationship between 18F-Flutemetamol uptake and RBANS performance in non-demented community-dwelling older adults

OBJECTIVE

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been used extensively for clinical care and in research for patients with mild cognitive impairment and Alzheimer's disease (AD); however, relatively few studies have evaluated the relationship between RBANS performance and AD imaging biomarkers. The purpose of the current study was to evaluate the association between a relatively new amyloid positron emission tomography imaging biomarker and performance on the RBANS.

METHODS

Twenty-seven nondemented community-dwelling adults over the age of 65 underwent ¹⁸F-Flutemetamol amyloid- positron emission tomography imaging, along with cognitive testing using the RBANS and select behavioral measures. Partial correlation coefficients were used to identify relationships between the imaging and behavioral markers.

RESULTS

After controlling for age and education, amyloid deposition and RBANS Indexes of Immediate Memory, Delayed Memory, and Total Scale score were significantly correlated (p's < .001, r's = -.73 to -.77, d's = 2.13-2.39), with greater amyloid burden being associated with lower RBANS scores. The Delayed Memory Index was particularly highly associated with ¹⁸F-Flutemetamol binding (r² = .59, p < .001, d = 2.39). Neither ¹⁸F-Flutemetamol binding nor RBANS performance was significantly correlated with levels of depression, subjective cognitive difficulties, or premorbid intellect.

CONCLUSIONS

Because of the limited use of amyloid imaging in clinical settings due to high cost and lack of reimbursement, these findings suggest that in particular RBANS Delayed Memory Index may be a cost-efficient tool to identify early signs of AD pathology, and its use may enlighten clinical decision-making regarding potential progression to dementia due to AD.

Evaluating Neurocognitive Deficits in Patients With Multiple Sclerosis Via a Brief Neuropsychological Approach

Recent research demonstrates neurocognitive deficits are present early in the sequelae of multiple sclerosis (MS). This is an important consideration given the functional activities of daily living, such as employment, that can be impacted by neurocognitive dysfunction. This study investigated the utility of a brief neuropsychological battery, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), to evaluate neurocognitive deficits in patients with MS and to examine the relationship between a measure of functional disability (Expanded Disability Status Scale [EDSS]) and the RBANS. Participants were 49 patients with MS (Mage = 45.39 years) who completed the RBANS as part of a neuropsychological assessment and 49 demographically matched healthy controls (Mage = 45.39 years). Multivariate analysis of variance revealed that the two groups differed on the RBANS. Descriptive discriminant analysis indicated the groups differed on domains of attention, language, immediate memory, and delayed memory. EDSS scores were a good predictor of neurocognitive dysfunction in patients with advanced disability but not for patients with mild disability. The RBANS seems to be effective in identifying cognitive dysfunction in patients with MS, and caution should be used in extrapolating cognitive deficits for patients with low EDSS scores.

Cerebral desaturation events during shoulder arthroscopy in the beach chair position: patient risk factors and neurocognitive effects

BACKGROUND

Patients undergoing shoulder surgery in the beach chair position may be at increased risk for serious neurocognitive complications due to cerebral ischemia. We sought to define the incidence, patient risk factors, and clinical sequelae of intraoperative cerebral desaturation events.

METHODS

Regional cerebral tissue oxygen saturation (rSO2) was monitored intra-operatively using near-infrared spectroscopy (NIRS) on 50 consecutive patients. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was administered to each patient pre- and postoperatively. Intra-operative decreases in rSO2 of 20% or greater were defined as cerebral desaturation events (CDE). The association between intraoperative CDE and postoperative cognitive decline was assessed.

RESULTS

The incidence of intraoperative CDE in our series was 18% (9/50). Increased body mass index (BMI) was found to have a statistically significant association with intraoperative CDE (mean BMI 37.32 vs 28.59, P < .0001). There was no statistical significance in pre- vs postoperative RBANS either in composite scores or any of the sub-indices in either group.

CONCLUSION

The degree and duration of cerebral ischemia required to produce neurocognitive dysfunction in this patient population remains undefined; however, cerebral oximetry with NIRS allows prompt identification and treatment of decreased cerebral perfusion decreasing the risk of this event. Increased BMI was found to be a statistically significant patient risk factor for the development of intra-operative CDE. The transient intra-operative CDEs were not associated with postoperative cognitive dysfunction in our patient series. We believe protocols aimed at detecting and reversing CDE minimize the risk of neurocognitive dysfunction and improve patient safety.

Everyday episodic memory in amnestic mild cognitive impairment: a preliminary investigation

BACKGROUND

Decline in episodic memory is one of the hallmark features of Alzheimer's disease (AD) and is also a defining feature of amnestic Mild Cognitive Impairment (MCI), which is posited as a potential prodrome of AD. While deficits in episodic memory are well documented in MCI, the nature of this impairment remains relatively under-researched, particularly for those domains with direct relevance and meaning for the patient's daily life. In order to fully explore the impact of disruption to the episodic memory system on everyday memory in MCI, we examined participants' episodic memory capacity using a battery of experimental tasks with real-world relevance. We investigated episodic acquisition and delayed recall (story-memory), associative memory (face-name pairings), spatial memory (route learning and recall), and memory for everyday mundane events in 16 amnestic MCI and 18 control participants. Furthermore, we followed MCI participants longitudinally to gain preliminary evidence regarding the possible predictive efficacy of these real-world episodic memory tasks for subsequent conversion to AD.

RESULTS

The most discriminating tests at baseline were measures of acquisition, delayed recall, and associative memory, followed by everyday memory, and spatial memory tasks, with MCI patients scoring significantly lower than controls. At follow-up (mean time elapsed: 22.4 months), 6 MCI cases had progressed to clinically probable AD. Exploratory logistic regression analyses revealed that delayed associative memory performance at baseline was a potential predictor of subsequent conversion to AD.

CONCLUSIONS

As a preliminary study, our findings suggest that simple associative memory paradigms with real-world relevance represent an important line of enquiry in future longitudinal studies charting MCI progression over time.