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Fillenbaum GG, Mohs R. CERAD (Consortium to Establish a Registry for Alzheimer's Disease) Neuropsychology Assessment Battery: 35 Years and Counting. J Alzheimers Dis 2023; 93:1-27. [PMID: 36938738 PMCID: PMC10175144 DOI: 10.3233/jad-230026] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND In 1986, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) was mandated to develop a brief neuropsychological assessment battery (CERAD-NAB) for AD, for uniform neuropsychological assessment, and information aggregation. Initially used across the National Institutes of Aging-funded Alzheimer's Disease Research Centers, it has become widely adopted wherever information is desired on cognitive status and change therein, particularly in older populations. OBJECTIVE Our purpose is to provide information on the multiple uses of the CERAD-NAB since its inception, and possible further developments. METHODS Since searching on "CERAD neuropsychological assessment battery" or similar terms missed important information, "CERAD" alone was entered into PubMed and SCOPUS, and CERAD-NAB use identified from the resulting studies. Use was sorted into major categories, e.g., psychometric information, norms, dementia/differential dementia diagnosis, epidemiology, intervention evaluation, genetics, etc., also translations, country of use, and alternative data gathering approaches. RESULTS CERAD-NAB is available in ∼20 languages. In addition to its initial purpose assessing AD severity, CERAD-NAB can identify mild cognitive impairment, facilitate differential dementia diagnosis, determine cognitive effects of naturally occurring and experimental interventions (e.g., air pollution, selenium in soil, exercise), has helped to clarify cognition/brain physiology-neuroanatomy, and assess cognitive status in dementia-risk conditions. Surveys of primary and tertiary care patients, and of population-based samples in multiple countries have provided information on prevalent and incident dementia, and cross-sectional and longitudinal norms for ages 35-100 years. CONCLUSION CERAD-NAB has fulfilled its original mandate, while its uses have expanded, keeping up with advances in the area of dementia.
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Affiliation(s)
- Gerda G Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Richard Mohs
- Global Alzheimer's Platform Foundation, Washington, DC, USA
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Cerullo E, Quinn TJ, McCleery J, Vounzoulaki E, Cooper NJ, Sutton AJ. Interrater agreement in dementia diagnosis: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2021; 36:1127-1147. [PMID: 33942363 DOI: 10.1002/gps.5499] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/27/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Dementia remains a clinical diagnosis with a degree of subjective assessment and potential for interrater disagreement. We described interrater agreement of clinical dementia diagnosis for various diagnostic criteria. METHODS We conducted a PROSPERO-registered (CRD42020168245) systematic review and meta-analysis. We searched multiple cross-disciplinary databases from inception until April 2020 for relevant papers, extracted data and described study quality in duplicate. Study quality was assessed using the Guidelines for Reporting Reliability and Agreement Studies. We used random-effects models to obtain summary estimates of interrater agreement using kappa and, where possible, Gwet's AC1/2 coefficients. RESULTS We found 7577 titles and 22 eligible studies. Meta-analysis was possible for all-cause dementia using the Diagnostic and Statistical Manual of Mental Disorders third edition revised (DSM-III-R) criteria (kappa = 0.66, 95% CI = [0.53,0.78]), Alzheimer's disease using the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's disease and Related Disorders Association (NINCDS-ADRDA) criteria (kappa = 0.71, 95% CI = [0.65,0.77] for presence/absence and AC2 = 0.61, 95% CI = [0.53,0.70] when distinguishing probable/possible cases), and vascular dementia using the International Classification of Diseases version 10 (ICD-10) criteria kappa = 0.79 (95% CI = [0.70,0.87]). Data was more limited for other criteria and dementia types. AC1/2 coefficients generally indicated higher agreement. One study was rated as high quality. CONCLUSIONS Diagnostic criteria for clinical dementia may have good but imperfect agreement. This has important implications for clinical practice and research studies, which frequently assume these criteria are perfect tests, such as diagnostic test accuracy studies frequently conducted for biomarkers and neuropsychological tests, and for trials where incident dementia is the outcome.
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Affiliation(s)
- Enzo Cerullo
- Department of Health Sciences, Biostatistics Research Group, University of Leicester, Leicester, UK.,NIHR Complex Reviews Support Unit, University of Leicester & University of Glasgow, Glasgow, UK
| | - Terry J Quinn
- NIHR Complex Reviews Support Unit, University of Leicester & University of Glasgow, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jenny McCleery
- Oxford Health NHS Foundation Trust, Elms Centre, Banbury, UK
| | - Elpida Vounzoulaki
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Nicola J Cooper
- Department of Health Sciences, Biostatistics Research Group, University of Leicester, Leicester, UK.,NIHR Complex Reviews Support Unit, University of Leicester & University of Glasgow, Glasgow, UK
| | - Alex J Sutton
- Department of Health Sciences, Biostatistics Research Group, University of Leicester, Leicester, UK.,NIHR Complex Reviews Support Unit, University of Leicester & University of Glasgow, Glasgow, UK
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Nguyen CM, Tan A, Nguyen A, Lee GJ, Qi WG, Thaler NS, Fujii D. Cross-cultural considerations for teleneuropsychology with Asian patients. Clin Neuropsychol 2021:1-15. [PMID: 34233583 DOI: 10.1080/13854046.2021.1948104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Recent teleneuropsychology (TeleNP) models provide some degree of guidance in the application of telecommunication technologies toward the practice of neuropsychology. However, there remains a paucity of peer-reviewed data on TeleNP practices with culturally diverse patients, including Asian patients. This manuscript describes the challenges related to TeleNP practices with Asian patients and offers practical recommendations to complement existing TeleNP guidelines. METHOD Based on extant literature on multicultural applications of neuropsychology, weprovide recommendations for TeleNP services with Asian patients that pertain to specific components of a TeleNP evaluation, such as a) pre-evaluation preparation, b) determining the appropriateness of the referral, c) determining language proficiency, d) working with interpreters, e) informed consent and confidentiality issues, f) conducting a culturally sensitive clinical interview, g) behavioral observations and communication, h) test selection, and i) interpreting data and writing reports. CONCLUSIONS Our recommendations for TeleNP services with Asian patients highlight the need for flexibility to accommodate cultural differences and commitment to the complex nature of working with patients requiring interpretation services, while also recognizing the importance of preserving the validity of neuropsychological methods. Moving forward, it is imperative that the field of neuropsychology increases the training and accessibility of neuropsychologists who are knowledgeable in providing TeleNP services to Asian patients, and promotes research on the validation of TeleNP for Asian and other ethnic minority groups.
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Affiliation(s)
- Christopher M Nguyen
- Department of Psychiatry & Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alexander Tan
- Department of Psychology, Children's Hospital of Orange County, Orange, CA, USA
| | - Ann Nguyen
- Department of Psychology, School of Behavioral Health, Loma Linda University, Loma Linda, CA, USA
| | - Grace J Lee
- Department of Psychiatry & Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Wei Gabriel Qi
- Department of Medical Psychology, School of Health Humanities, Peking University, Beijing, China
| | - Nicholas S Thaler
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
| | - Daryl Fujii
- Veterans Affairs Pacific Island Health Care Services, Honolulu, HI, USA
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Pasqual E, Boussin F, Bazyka D, Nordenskjold A, Yamada M, Ozasa K, Pazzaglia S, Roy L, Thierry-Chef I, de Vathaire F, Benotmane MA, Cardis E. Cognitive effects of low dose of ionizing radiation - Lessons learned and research gaps from epidemiological and biological studies. ENVIRONMENT INTERNATIONAL 2021; 147:106295. [PMID: 33341586 DOI: 10.1016/j.envint.2020.106295] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/02/2020] [Accepted: 10/20/2020] [Indexed: 06/12/2023]
Abstract
The last decades have seen increased concern about the possible effects of low to moderate doses of ionizing radiation (IR) exposure on cognitive function. An interdisciplinary group of experts (biologists, epidemiologists, dosimetrists and clinicians) in this field gathered together in the framework of the European MELODI workshop on non-cancer effects of IR to summarise the state of knowledge on the topic and elaborate research recommendations for future studies in this area. Overall, there is evidence of cognitive effects from low IR doses both from biology and epidemiology, though a better characterization of effects and understanding of mechanisms is needed. There is a need to better describe the specific cognitive function or diseases that may be affected by radiation exposure. Such cognitive deficit characterization should consider the human life span, as effects might differ with age at exposure and at outcome assessment. Measurements of biomarkers, including imaging, will likely help our understanding on the mechanism of cognitive-related radiation induced deficit. The identification of loci of individual genetic susceptibility and the study of gene expression may help identify individuals at higher risk. The mechanisms behind the radiation induced cognitive effects are not clear and are likely to involve several biological pathways and different cell types. Well conducted research in large epidemiological cohorts and experimental studies in appropriate animal models are needed to improve the understanding of radiation-induced cognitive effects. Results may then be translated into recommendations for clinical radiation oncology and imaging decision making processes.
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Affiliation(s)
- Elisa Pasqual
- Barcelona Institute for Global Health (ISGlobal), Campus Mar, Barcelona Biomedical Research Park (PRBB), Dr Aiguader 88, 08003 Barcelona, Spain; University Pompeu Fabra, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Madrid, Spain.
| | - François Boussin
- Université de Paris and Université Paris-Saclay, Inserm, LRP/iRCM/IBFJ CEA, UMR Stabilité Génétique Cellules Souches et Radiations, F-92265 Fontenay-aux-Roses, France
| | - Dimitry Bazyka
- National Research Center for Radiation Medicine, 53 Illenko str., Kyiv, Ukraine
| | - Arvid Nordenskjold
- Department of Clinical Neuroscience, Division of Neurology, Karolinska Institutet, Stockholm, Sweden
| | - Michiko Yamada
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Kotaro Ozasa
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Simonetta Pazzaglia
- Laboratory of Biomedical Technologies, ENEA CR-Casaccia, Via Anguillarese 301, 00123 Rome, Italy
| | - Laurence Roy
- Department for Research on the Biological and Health Effects of Ionising Radiation. Institut of Radiation Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health (ISGlobal), Campus Mar, Barcelona Biomedical Research Park (PRBB), Dr Aiguader 88, 08003 Barcelona, Spain; University Pompeu Fabra, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Madrid, Spain
| | - Florent de Vathaire
- Radiation Epidemiology Teams, INSERM Unit 1018, University Paris Saclay, Gustave Roussy, 94800 Villejuif, France
| | | | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Campus Mar, Barcelona Biomedical Research Park (PRBB), Dr Aiguader 88, 08003 Barcelona, Spain; University Pompeu Fabra, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Madrid, Spain
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Heterogeneity in 14-year Dementia Incidence Between Asian American Subgroups. Alzheimer Dis Assoc Disord 2018; 31:181-186. [PMID: 28406845 DOI: 10.1097/wad.0000000000000189] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Asian Americans are a rapidly growing and diverse population. Prior research on dementia among Asian Americans focused on Japanese Americans or Asian Americans overall, although marked differences in cardiometabolic conditions between subgroups have been documented. MATERIALS AND METHODS We compared dementia incidence among 4 Asian American subgroups (n=8384 Chinese; n=4478 Japanese; n=6210 Filipino; n=197 South Asian) and whites (n=206,490) who were Kaiser Permanente Northern California members aged 64 years and above with no dementia diagnoses as of January 1, 2000. Dementia diagnoses were collected from medical records January 1, 2000 to December 31, 2013. Baseline medical utilization and comorbidities (diabetes, depression, hypertension, stroke, cardiovascular disease) were abstracted from medical records January 1, 1996 to December 31, 1999. We calculated age-standardized dementia incidence rates and Cox models adjusted for age, sex, medical utilization, and comorbidities. RESULTS Mean baseline age was 71.7 years; mean follow-up was 9.6 years. Age-standardized dementia incidence rates were higher among whites than "All Asian-Americans" or any subgroup. Compared with Chinese (13.7/1000 person-years), dementia incidence was slightly higher among Japanese [14.8/1000 person-years; covariate-adjusted hazard ratio (adjusted-HR)=1.08; 95% confidence interval (CI), 0.99-1.18] and Filipinos (17.3/1000 person-years; adjusted-HR=1.20; 95% CI, 1.11-1.31), and lower among South Asians (12.1/1000 person-years; adjusted-HR=0.81; 95% CI, 0.53-1.25). CONCLUSIONS Future studies are needed to understand how immigration history, social, environmental, and genetic factors contribute to dementia risk in the growing and diverse Asian American population.
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Miki T, Shimada H, Kim JS, Yamamoto Y, Sugino M, Kowa H, Heurling K, Zanette M, Sherwin PF, Senda M. Brain uptake and safety of Flutemetamol F 18 injection in Japanese subjects with probable Alzheimer's disease, subjects with amnestic mild cognitive impairment and healthy volunteers. Ann Nucl Med 2017; 31:260-272. [PMID: 28181118 PMCID: PMC5352784 DOI: 10.1007/s12149-017-1154-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/15/2017] [Indexed: 11/30/2022]
Abstract
Objective This Phase 2 study assessed the performance of positron emission tomography (PET) brain images made with Flutemetamol F 18 Injection in detecting β-amyloid neuritic plaques in Japanese subjects. Methods Seventy subjects (25 with probable Alzheimer’s disease (pAD), 20 with amnestic mild cognitive impairment (aMCI), and 25 cognitively normal healthy volunteers[HVs]) underwent PET brain imaging after intravenous Flutemetamol F 18 Injection (185 MBq). Images were interpreted as normal or abnormal for neuritic plaque density by each of five non-Japanese and five Japanese readers who were blinded to clinical data. The primary efficacy analysis (based on HV and pAD data) was the agreement of the non-Japanese readers’ image interpretations with the clinical diagnosis, resulting in estimates of positive percent agreement (PPA; based on AD subjects; similar to sensitivity) and negative percent agreement (NPA; based on HVs; similar to specificity). Secondary analyses included PPA and NPA for the Japanese readers; inter-reader agreement (IRA); intra-reader reproducibility (IRR); quantitative image interpretations (standardized uptake value ratios [SUVRs]) by diagnostic subgroup; test–retest variability in five pAD subjects; and safety. Results PPA was 92% for all non-Japanese readers and ranged from 88 to 92% for the Japanese readers. NPA ranged from 96 to 100% for both the non-Japanese readers and the Japanese readers. The majority image interpretations (the interpretations made independently by ≥3 of 5 readers) resulted in PPA values of 92 and 92% and NPA values of 100 and 96% for the non-Japanese and Japanese readers, respectively. IRA and IRR were strong. Composite SUVR values (mean of multiple regional values) allowed clear differentiation between pAD subjects and HVs. Test–retest variability ranged from 1.14 to 2.27%, and test–retest agreement of the blinded visual interpretations was 100% for all readers. Flutemetamol F 18 Injection was generally well tolerated. Conclusions The detection of brain neuritic plaques in Japanese subjects using [18F]Flutemetamol PET images gave results highly consistent with clinical diagnosis, with non-Japanese and Japanese readers giving similar results. Inter-reader agreement and intra-reader reproducibility were high for both sets of readers. Visual delineation of abnormal and normal scans was corroborated by quantitative assessment, with low test–retest variability. Trial registration Clinicaltrials.gov registration number NCT02813070. Electronic supplementary material The online version of this article (doi:10.1007/s12149-017-1154-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Takami Miki
- Department of Geriatrics, Osaka City University Hospital, 5-7, Asahi-machi 1-chome, Abeno-ku, Osaka City, Japan. .,Izumiotsu Municipal Hospital, Shimojyo-chou 16-1, Izumiotsu, Osaka, 595-0027, Japan.
| | - Hiroyuki Shimada
- Department of Geriatrics, Osaka City University Hospital, 5-7, Asahi-machi 1-chome, Abeno-ku, Osaka City, Japan
| | - Jae-Seung Kim
- Nuclear Medicine Department, Asan Medical Center, 388-1 Pungnap-2 Dong, Songpa-Gu, Seoul, South Korea
| | - Yasuji Yamamoto
- Neuropsychiatry Department, Kobe University Hospital, 5-2, Kusunoki-cho 7-chome, Chuo-ku, Kobe City, Hyogo Prefecture, Japan
| | - Masakazu Sugino
- Aino Hospital, Center of Geriatric Somato-Psychological Care, 11-18, Takada-cho, Ibaraki City, Osaka, Japan
| | - Hisatomo Kowa
- Neurology Department, Kobe University Hospital, 5-2, Kusunoki-cho 7-chome, Chuo-ku, Kobe City, Hyogo Prefecture, Japan
| | - Kerstin Heurling
- GE Healthcare, Uppsala, Sweden.,Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden
| | | | | | - Michio Senda
- Positron Medical Department, Institute of Biomedical Research and Innovation Hospital, 2, Minatojima Minami-machi 2-chome, Chuo-ku, Kobe City, Hyogo Prefecture, Japan
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Yamada M, Landes RD, Mimori Y, Nagano Y, Sasaki H. Radiation Effects on Cognitive Function Among Atomic Bomb Survivors Exposed at or After Adolescence. Am J Med 2016; 129:586-91. [PMID: 26477949 DOI: 10.1016/j.amjmed.2015.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/09/2015] [Accepted: 09/10/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND The objective of this study was to investigate radiation effects on longitudinal pre-dementia cognitive decline among participants who developed dementia as well as on those who did not develop dementia during follow-up. METHODS Measuring cognitive function with the Cognitive Abilities Screening Instrument approximately every 2 years, we followed 1844 atomic bomb survivors participating in the Adult Health Study of the Radiation Effects Research Foundation from 1992 to 2011. Participants were adolescents or older when exposed to between 0 and 4 Gy. Approximately 15% and 40% of participants were exposed to ≥1 Gy and <5 mGy, respectively. At study start, participants were dementia-free and between 60 and 80 years old. Three-quarters of the participants returned after baseline, averaging 8.4 years of follow-up. During follow-up, 313 developed dementia. We used cognitive scores before dementia onset for analysis and a mixed-effects model to estimate radiation effects on longitudinal change of cognition, adjusting for dementia occurrence, age, sex, and education. RESULTS Cognition level was significantly associated with age, education, and dementia occurrence but not with radiation dose or sex. Cognitive decline accelerated with increasing age, especially among participants who developed dementia. Neither radiation nor education was significantly associated with the degree of deterioration with age. Radiation did not modify the different cognitive decline by dementia occurrence. CONCLUSIONS Radiation did not significantly affect cognition among atomic bomb survivors exposed at or after adolescence.
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Affiliation(s)
- Michiko Yamada
- Departments of Clinical Studies and Statistics, Radiation Effects Research Foundation, Hiroshima, Japan.
| | - Reid D Landes
- Departments of Clinical Studies and Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Yasuyo Mimori
- Department of Physical Therapy, Hiroshima International University, Higashi-Hiroshima, Japan
| | - Yoshito Nagano
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan
| | - Hideo Sasaki
- Department of Nutritional Sciences, Yasuda Women's University, Hiroshima, Japan
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Yamada M, Landes RD, Mimori Y, Nagano Y, Sasaki H. Trajectories of cognitive function in dementia-free subjects: Radiation Effects Research Foundation Adult Health Study. J Neurol Sci 2015; 351:115-119. [DOI: 10.1016/j.jns.2015.02.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/05/2015] [Accepted: 02/27/2015] [Indexed: 11/28/2022]
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Incidence rates of dementia, Alzheimer disease, and vascular dementia in the Japanese American population in Seattle, WA: the Kame Project. Alzheimer Dis Assoc Disord 2014; 28:23-9. [PMID: 24045327 DOI: 10.1097/wad.0b013e3182a2e32f] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are few studies on the incidence of dementia in representative minority populations in the United States; however, no population-based study has been conducted on Japanese American women. We identified 3045 individuals aged 65+ with at least 1 parent of Japanese descent living in King County, WA in the period 1992 to 1994, of whom 1836 were dementia-free and were examined every 2 years (1994 to 2001) to identify incident cases of all dementias, Alzheimer disease (AD), vascular dementia (VaD), and other dementias. Cox regression was used to examine associations with age, sex, years of education, and apolipoprotein (APOE)-ε4. Among 173 incident cases of dementia, the overall rate was 14.4/1000/y, with rates being slightly higher among women (15.9/1000) than men (12.5/1000). Rates roughly doubled every 5 years for dementia and AD; the age trend for VaD and other dementias was less consistent. Sex was not significantly related to incidence of dementia or its subtypes in adjusted models. There was a trend for an inverse association with increasing years of education. APOE-ε4 was a strong risk factor for all dementias [hazard ratio (HR)=2.89; 95% confidence interval (CI), 1.88-4.46], AD (HR=3.27; 95% CI, 2.03-5.28), and VaD (HR=3.33; 95% CI, 1.34-8.27). This study is the first to report population-based incidence rates for both Japanese American men and women.
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Knopman DS, Petersen RC, Rocca WA, Larson EB, Ganguli M. Passive case-finding for Alzheimer's disease and dementia in two U.S. communities. Alzheimers Dement 2011; 7:53-60. [PMID: 21255743 DOI: 10.1016/j.jalz.2010.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Passive surveillance for disease is a public health approach that relies on documentation available within existing health records for the region or community being studied. Its two primary advantages over active case-finding are the lower cost of research and the lower burden on the population under study. The effectiveness of passive case-finding depends on the comprehensiveness of the healthcare coverage in a given community and the adequacy of the available medical records. The Rochester Epidemiology Project has permitted dementia case detection for Olmsted County, Minnesota, using a medical records-linkage system. These data were compared with case ascertainment using direct assessment of individuals in an epidemiological study of the same community. At the Group Health Research Institute, investigators compared dementia and Alzheimer's disease cases detected using an electronic medical record database search with those identified by a parallel active case-finding study. In this article, the advantages and disadvantages of passive case-finding were discussed, and the following conclusion was drawn: the purpose of the study being conducted should determine the case-finding approach that is to be used.
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Affiliation(s)
- David S Knopman
- Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN, USA.
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11
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Incidence and risks of dementia in Japanese women: Radiation Effects Research Foundation Adult Health Study. J Neurol Sci 2009; 283:57-61. [DOI: 10.1016/j.jns.2009.02.338] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Yamada M, Kasagi F, Mimori Y, Miyachi T, Ohshita T, Sasaki H. Incidence of dementia among atomic-bomb survivors — Radiation Effects Research Foundation Adult Health Study. J Neurol Sci 2009; 281:11-4. [DOI: 10.1016/j.jns.2009.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 02/17/2009] [Accepted: 03/09/2009] [Indexed: 11/25/2022]
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Japanese-English language equivalence of the Cognitive Abilities Screening Instrument among Japanese-Americans. Int Psychogeriatr 2009; 21:129-37. [PMID: 18947456 PMCID: PMC2746009 DOI: 10.1017/s1041610208007862] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The Cognitive Abilities Screening Instrument (CASI) was designed for use in cross-cultural studies of Japanese and Japanese-American elderly in Japan and the U.S.A. The measurement equivalence in Japanese and English had not been confirmed in prior studies. METHODS We analyzed the 40 CASI items for differential item functioning (DIF) related to test language, as well as self-reported proficiency with written Japanese, age, and educational attainment in two large epidemiologic studies of Japanese-American elderly: the Kame Project (n=1708) and the Honolulu-Asia Aging Study (HAAS; n = 3148). DIF was present if the demographic groups differed in the probability of success on an item, after controlling for their underlying cognitive functioning ability. RESULTS While seven CASI items had DIF related to language of testing in Kame (registration of one item; recall of one item; similes; judgment; repeating a phrase; reading and performing a command; and following a three-step instruction), the impact of DIF on participants' scores was minimal. Mean scores for Japanese and English speakers in Kame changed by <0.1 SD after accounting for DIF related to test language. In HAAS, insufficient numbers of participants were tested in Japanese to assess DIF related to test language. In both studies, DIF related to written Japanese proficiency, age, and educational attainment had minimal impact. CONCLUSIONS To the extent that DIF could be assessed, the CASI appeared to meet the goal of measuring cognitive function equivalently in Japanese and English. Stratified data collection would be needed to confirm this conclusion. DIF assessment should be used in other studies with multiple language groups to confirm that measures function equivalently or, if not, form scores that account for DIF.
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Yamada M, Mimori Y, Kasagi F, Miyachi T, Ohshita T, Sudoh S, Ikeda J, Matsui K, Nakamura S, Matsumoto M, Fujiwara S, Sasaki H. Incidence of dementia, Alzheimer disease, and vascular dementia in a Japanese population: Radiation Effects Research Foundation adult health study. Neuroepidemiology 2008; 30:152-60. [PMID: 18382114 DOI: 10.1159/000122332] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2007] [Accepted: 01/07/2008] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the age-, sex-, and subtype-specific incidence of dementia and to assess the effect of education level on the incidence in a Japanese population. METHODS 2,286 dementia-free subjects, aged > or =60 years, were followed for 5.9 years through biennial two-phase examinations. RESULTS 206 cases of dementia were newly diagnosed based on DSM IV. The incidence per 1,000 person-years was 12.0 for men and 16.6 for women. Based on NINCDS-ADRDA criteria, 80 cases of probable Alzheimer disease (AD) and 50 cases of possible AD were diagnosed. Based on NINDS-AIREN criteria, 36 cases of probable vascular dementia (VaD) and 40 cases of possible VaD were diagnosed. Age and education showed the most statistically significant effects for all dementia. Probable AD showed the most remarkable increase with age and decreased with increasing education level (p = 0.001). Probable VaD showed significant effects of sex (p = 0.033) and sex-age interaction (p = 0.048), but not education (p = 0.26). CONCLUSION AD was the predominant type of dementia in this recent incidence study conducted in Japan, suggesting a reduction in VaD and an increase in AD. Age, sex, and education effects differed by dementia subtype.
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Affiliation(s)
- Michiko Yamada
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima, Japan.
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Clinical diagnosis of dementia. Alzheimers Dement 2007; 3:292-8. [DOI: 10.1016/j.jalz.2007.08.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Revised: 08/08/2007] [Accepted: 08/09/2007] [Indexed: 11/19/2022]
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Dai Q, Borenstein AR, Wu Y, Jackson JC, Larson EB. Fruit and vegetable juices and Alzheimer's disease: the Kame Project. Am J Med 2006; 119:751-9. [PMID: 16945610 PMCID: PMC2266591 DOI: 10.1016/j.amjmed.2006.03.045] [Citation(s) in RCA: 286] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Revised: 03/22/2006] [Accepted: 03/22/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Growing evidence suggests that oxidative damage caused by the beta-amyloid peptide in the pathogenesis of Alzheimer's disease may be hydrogen peroxide mediated. Many polyphenols, the most abundant dietary antioxidants, possess stronger neuroprotection against hydrogen peroxide than antioxidant vitamins. METHODS We tested whether consumption of fruit and vegetable juices, containing a high concentration of polyphenols, decreases the risk of incident probable Alzheimer's disease in the Kame Project cohort, a population-based prospective study of 1836 Japanese Americans in King County, Washington, who were dementia-free at baseline (1992-1994) and were followed through 2001. RESULTS After adjustment for potential confounders, the hazard ratio for probable Alzheimer's disease was 0.24 (95% confidence interval [CI], 0.09-0.61) comparing subjects who drank juices at least 3 times per week with those who drank less often than once per week with a hazard ratio of 0.84 (95% CI, 0.31-2.29) for those drinking juices 1 to 2 times per week (P for trend < .01). This inverse association tended to be more pronounced among those with an apolipoprotein Eepsilon-4 allele and those who were not physically active. Conversely, no association was observed for dietary intake of vitamins E, C, or beta-carotene or tea consumption. CONCLUSIONS Fruit and vegetable juices may play an important role in delaying the onset of Alzheimer's disease, particularly among those who are at high risk for the disease. These results may lead to a new avenue of inquiry in the prevention of Alzheimer's disease.
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Affiliation(s)
- Qi Dai
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt Center for Health Services Research, Vanderbilt-Ingram Cancer Center, Vanderbilt School of Medicine, Nashville, Tenn, USA.
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Borenstein AR, Wu Y, Mortimer JA, Schellenberg GD, McCormick WC, Bowen JD, McCurry S, Larson EB. Developmental and vascular risk factors for Alzheimer's disease. Neurobiol Aging 2005; 26:325-34. [PMID: 15639310 DOI: 10.1016/j.neurobiolaging.2004.04.010] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2003] [Revised: 03/15/2004] [Accepted: 04/05/2004] [Indexed: 11/22/2022]
Abstract
To investigate developmental and vascular risk factors for Alzheimer's disease (AD), we examined 90 incident cases of probable AD in a cohort of 1859 individuals followed prospectively for six years. The presence of the APOE-epsilon4 allele was the strongest risk factor, and with increasing survival age, the effect of epsilon4 diminished. Among epsilon4 positives, developmental risk factors such as smaller head circumference (< or =54.4 cm) and having more than four children in the household at age 2-3 were independently associated with incident AD (hazard ratio (HR)=2.6 (95% CI 1.04-6.3) and 3.3 (1.2-9.2), respectively). Among epsilon4 negatives, vascular risk factors were related to AD risk (self-reported diagnoses of transient ischemic attack and diabetes (HR=5.1, 95% CI 1.7-15.5; HR 3.3, 95% CI 1.4-8.1)). These findings indicate that clinical AD is a result of early life as well as later life risk factors, and that genetic predisposition to the disease may modify the constellation of predictors.
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Affiliation(s)
- Amy R Borenstein
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., Tampa, FL 33612-3805, USA.
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Fillenbaum GG, McCurry SM, Kuchibhatla M, Masaki KH, Borenstein AR, Foley DJ, Heyman A, Larson EB, White L. Performance on the CERAD neuropsychology battery of two samples of Japanese-American elders: norms for persons with and without dementia. J Int Neuropsychol Soc 2005; 11:192-201. [PMID: 15966108 DOI: 10.1017/s1355617705050198] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Norms for cognitive measures used to assess dementia are scant for minority groups, in particular for older Japanese Americans. Using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Neuropsychology Battery, we compared the baseline performance of demented and nondemented Japanese Americans. Participants came from two harmonized epidemiological studies of dementia which were examined separately: the Kame Project, Seattle (350 men and women; 201 nondemented), age 65 and older; Honolulu-Asia Aging Study (HAAS), Hawaii (418 men; 120 nondemented), age 71 and older. The measures examined were Verbal Fluency; abbreviated Boston Naming; constructional praxis; and Word List Learning, Recall, and Recognition. Within each study, the CERAD measures distinguished between nondemented participants and those with mild cognitive impairment. Among persons with dementia, average level of performance decreased as severity of dementia increased. Determinants of score (age, education, language of administration, stage of dementia) varied between the two studies. Among Japanese Americans, the CERAD Neuropsychology Battery distinguished nondemented persons from those with dementia, but was less consistent in distinguishing levels of severity of dementia. This battery is useful for comparative epidemiological studies of dementia in minority populations.
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Affiliation(s)
- Gerda G Fillenbaum
- Center for the Study of Aging and Human Development, Box 3003, Duke University Medical Center, Durham, NC 27710, USA.
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Knopman DS, Boeve BF, Petersen RC. Essentials of the proper diagnoses of mild cognitive impairment, dementia, and major subtypes of dementia. Mayo Clin Proc 2003; 78:1290-308. [PMID: 14531488 DOI: 10.4065/78.10.1290] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Loss of cognitive function in the elderly population is a common condition encountered in general medical practice. Diagnostic criteria and approaches have become more refined and explicit in the past several years. Precise diagnosis is feasible clinically. In this article, the precursor state and major subtypes of dementia are considered. Mild cognitive impairment is the term given to patients with cognitive impairment that is detectable by clinical criteria but does not produce impairment in daily functioning. When daily functioning is impaired as a result of cognitive decline, dementia is the appropriate syndromic label. Specific causes of dementia tend to have distinctive clinical presentations: the anterograde amnesic syndrome of Alzheimer disease; the syndrome of dementia with cerebrovascular disease; the syndrome of Lewy body dementia with its distinctive constellation of extrapyramidal features, disordered arousal, and dementia; the behavioral-cognitive syndrome of frontotemporal dementia; the primary progressive aphasias; and the rapidly progressive dementias. Because dementia syndromes have distinctive natural histories, precise diagnosis leads to a better understanding of prognosis. As new treatments become available for Alzheimer disease, the most common of the dementias, accurate diagnosis allows the appropriate patients to receive treatment.
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Affiliation(s)
- David S Knopman
- Department of Neurology and Alzheimer's Disease Research Center, Mayo Clinic, Rochester Minn 55905, USA
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Yamada M, Kasagi F, Sasaki H, Masunari N, Mimori Y, Suzuki G. Association between dementia and midlife risk factors: the Radiation Effects Research Foundation Adult Health Study. J Am Geriatr Soc 2003; 51:410-4. [PMID: 12588587 DOI: 10.1046/j.1532-5415.2003.51117.x] [Citation(s) in RCA: 158] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To investigate the association between midlife risk factors and the development of vascular dementia (VaD) or Alzheimer's disease (AD) 25 to 30 years later. DESIGN A prevalence study within a longitudinal cohort study. SETTING Subjects in the Adult Health Study (a prospective cohort study begun in 1958) have been followed through biennial medical examinations in Hiroshima, Japan. PARTICIPANTS One thousand seven hundred seventy-four subjects in Hiroshima, Japan born before September 1932 (1,660 with no dementia, 114 with dementia (51 with AD, and 38 with VaD) diagnosed from 1992 to 1997 according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria). MEASUREMENTS The subjects were examined for effect on dementia of sex, age, education, atomic bomb radiation dose, and midlife factors associated with risk (smoking, alcohol intake, physical activity, dietary habits, systolic blood pressure (SBP), body mass index, and history of diabetes mellitus) that had been evaluated in 1965-1970. RESULTS VaD prevalence increased significantly with age, higher SBP, and lower milk intake. The odds ratios of VaD for age (in 5-year increments), SBP (10 mmHg increments), and milk intake (almost daily/less than four times a week) were 1.29, 1.33, and 0.35, respectively. The risk factors for VaD were compatible with the risk factors for stroke in this study population. AD prevalence increased significantly with age and lower education. Other midlife factors and radiation dose did not show any significant association with VaD or AD. CONCLUSION Increased SBP and low milk intake in midlife were associated with VaD detected 25 to 30 years later. Early behavioral control of the risk factors for vascular disease might reduce the risk of dementia.
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Affiliation(s)
- Michiko Yamada
- Department of Clinical Studies, Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-815, Japan.
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Knopman DS, DeKosky ST, Cummings JL, Chui H, Corey-Bloom J, Relkin N, Small GW, Miller B, Stevens JC. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001; 56:1143-53. [PMID: 11342678 DOI: 10.1212/wnl.56.9.1143] [Citation(s) in RCA: 917] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To update the 1994 practice parameter for the diagnosis of dementia in the elderly. BACKGROUND The AAN previously published a practice parameter on dementia in 1994. New research and clinical developments warrant an update of some aspects of diagnosis. METHODS Studies published in English from 1985 through 1999 were identified that addressed four questions: 1) Are the current criteria for the diagnosis of dementia reliable? 2) Are the current diagnostic criteria able to establish a diagnosis for the prevalent dementias in the elderly? 3) Do laboratory tests improve the accuracy of the clinical diagnosis of dementing illness? 4) What comorbidities should be evaluated in elderly patients undergoing an initial assessment for dementia? RECOMMENDATIONS Based on evidence in the literature, the following recommendations are made. 1) The DSM-III-R definition of dementia is reliable and should be used (Guideline). 2) The National Institute of Neurologic, Communicative Disorders and Stroke--AD and Related Disorders Association (NINCDS-ADRDA) or the Diagnostic and Statistical Manual, 3rd edition, revised (DSM-IIIR) diagnostic criteria for AD and clinical criteria for Creutzfeldt--Jakob disease (CJD) have sufficient reliability and validity and should be used (Guideline). Diagnostic criteria for vascular dementia, dementia with Lewy bodies, and frontotemporal dementia may be of use in clinical practice (Option) but have imperfect reliability and validity. 3) Structural neuroimaging with either a noncontrast CT or MR scan in the initial evaluation of patients with dementia is appropriate. Because of insufficient data on validity, no other imaging procedure is recommended (Guideline). There are currently no genetic markers recommended for routine diagnostic purposes (Guideline). The CSF 14-3-3 protein is useful for confirming or rejecting the diagnosis of CJD (Guideline). 4) Screening for depression, B(12) deficiency, and hypothyroidism should be performed (Guideline). Screening for syphilis in patients with dementia is not justified unless clinical suspicion for neurosyphilis is present (Guideline). CONCLUSIONS Diagnostic criteria for dementia have improved since the 1994 practice parameter. Further research is needed to improve clinical definitions of dementia and its subtypes, as well as to determine the utility of various instruments of neuroimaging, biomarkers, and genetic testing in increasing diagnostic accuracy.
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Affiliation(s)
- D S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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