1
|
Yliranta A, Karjalainen VL, Nuorva J, Ahmasalo R, Jehkonen M. Apraxia testing to distinguish early Alzheimer's disease from psychiatric causes of cognitive impairment. Clin Neuropsychol 2023; 37:1629-1650. [PMID: 36829305 DOI: 10.1080/13854046.2023.2181223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/10/2023] [Indexed: 02/26/2023]
Abstract
Objective: Mood- and stress-related disorders commonly cause attentional and memory impairments in middle-aged individuals. In memory testing, these impairments can be mistakenly interpreted as symptoms of dementia; thus, more reliable diagnostic approaches are needed. The present work defines the discriminant accuracy of the Dementia Apraxia Test (DATE) between psychiatric conditions and early-onset Alzheimer's disease (AD) on its own and in combination with memory tests. Method: The consecutive sample included 50-70-year-old patients referred to dementia investigations for recent cognitive and/or affective symptoms. The DATE was administered and scored as a blinded measurement, and a receiver operating curve analysis was used to define the optimal diagnostic cut-off score. Results: A total of 24 patients were diagnosed with probable AD (mean age 61 ± 4) and 23 with a psychiatric condition (mean age 57 ± 4). The AD patients showed remarkable limb apraxia, but the psychiatric patients mainly performed at a healthy level on the DATE. The test showed a total discriminant accuracy of 87% for a total sum cut-off of 47 (sensitivity 79% and specificity 96%). The limb subscale alone reached an accuracy of 91% for a cut-off of 20 (sensitivity 83% and specificity 100%). All memory tests were diagnostically less accurate, while the combination of the limb praxis subscale and a verbal episodic memory test suggested a correct diagnosis in all but one patient. Conclusions: Apraxia testing may improve the accuracy of differentiation between AD and psychiatric aetiologies. Its potential in severe and chronic psychiatric conditions should be examined in the future.
Collapse
Affiliation(s)
- Aino Yliranta
- Faculty of Social Sciences, Tampere University
- Neurology Clinic, Lapland Central Hospital
| | | | | | | | | |
Collapse
|
3
|
Gauthier K, Morand A, Dutheil F, Alescio-Lautier B, Boucraut J, Clarys D, Eustache F, Girard N, Guedj E, Mazerolle M, Paccalin M, de la Sayette V, Zaréa A, Huguet P, Michel BF, Desgranges B, Régner I. Ageing stereotypes and prodromal Alzheimer's disease (AGING): study protocol for an ongoing randomised clinical study. BMJ Open 2019; 9:e032265. [PMID: 31594904 PMCID: PMC6797355 DOI: 10.1136/bmjopen-2019-032265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The number of older people diagnosed with amnestic mild cognitive impairment (aMCI), the prodromal state of Alzheimer's disease (AD), is increasing worldwide. However, some patients with aMCI never convert to the AD type of dementia, with some remaining stable and others reverting to normal. This overdiagnosis bias has been largely overlooked and gone unexplained. There is ample evidence in the laboratory that negative ageing stereotypes (eg, the culturally shared belief that ageing inescapably causes severe cognitive decline) contribute to the deteriorating cognitive performances of healthy older adults, leading them to perform below their true abilities. The study described here is intended to test for the first time whether such stereotypes also impair patients' cognitive performances during neuropsychological examinations in memory clinics, resulting in overdiagnosis of aMCI. METHODS AND ANALYSIS The ongoing study is a 4-year randomised clinical trial comparing patients' physiological stress and cognitive performances during neuropsychological testing in memory clinics. A total of 260 patients attending their first cognitive evaluation will be randomised to either a standard condition of test administration, assumed here to implicitly activate negative ageing stereotypes or a reduced-threat instruction condition designed to alleviate the anxiety arising from these stereotypes. Both groups will be tested with the same test battery and stress biomarkers. For 30 patients diagnosed with aMCI in each group (n=60), biomarkers of neurodegeneration and amyloidopathy will be used to distinguish between aMCI with normal versus abnormal AD biomarkers. A 9-month follow-up will be performed on all patients to identify those whose cognitive performances remain stable, deteriorate or improve. ETHICS AND DISSEMINATION This protocol has been approved by the French National Agency for Medicines and Health Products Safety and the Sud-Est I French Ethics Committee (2017-A00946-47). Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03138018.
Collapse
Affiliation(s)
- Kim Gauthier
- Aix Marseille Univ, CNRS, LPC, Marseille, France
| | - Alexandrine Morand
- Normandie Université, UNICAEN, PSL Universités Paris, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Frederic Dutheil
- Université Clermont Auvergne, CNRS, LAPSCO, Clermont-Ferrand, France
- Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, Clermont-Ferrand, France
| | | | - José Boucraut
- Immunology Laboratory, Assistance Publique-Hôpitaux de Marseille, Conception Hospital, Marseille, France
- Timone Neuroscience Institute, Aix-Marseille Univ, Marseille, France
| | - David Clarys
- Centre de Recherches sur la Cognition et l'Apprentissage, CNRS, Université de Poitiers, Université de Tours, Poitiers, France
| | - Francis Eustache
- Normandie Université, UNICAEN, PSL Universités Paris, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Nadine Girard
- Aix Marseille Univ, CRMBM UMR CNRS 7339, APHM Timone Neuroradiologie, Marseille, France
| | - Eric Guedj
- Aix Marseille Univ, CNRS, Ecole Centrale Marseille, UMR 7249, Institut Fresnel, & Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Marseille, Timone University Hospital, Marseille, France
| | - Marie Mazerolle
- Department and Laboratory of Psychology, MSHE, Université Bourgogne Franche-Comté, Besançon, France
| | - Marc Paccalin
- Centre d'Investigation Clinique CIC 1402, INSERM, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Vincent de la Sayette
- Normandie Université, UNICAEN, PSL Universités Paris, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Aline Zaréa
- Department of Neurology, Rouen University Hospital and University of Rouen, Rouen, France
| | - Pascal Huguet
- Université Clermont Auvergne, CNRS, LAPSCO, Clermont-Ferrand, France
| | - Bernard F Michel
- Departement of Neurological Behavior, Assistance Publique-Hôpitaux de Marseille, Sainte-Marguerite University Hospital, Marseille, France
| | - Béatrice Desgranges
- Normandie Université, UNICAEN, PSL Universités Paris, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | | |
Collapse
|
4
|
Population Base Rates and Disease Course of Common Psychiatric and Neurodegenerative Disorders. Neuropsychol Rev 2017; 27:284-301. [PMID: 28939959 DOI: 10.1007/s11065-017-9357-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 07/25/2017] [Indexed: 12/11/2022]
Abstract
Knowledge of population base rates of neurological and psychiatric disorders is fundamental for diagnostic decision making. Consideration of relevant probabilistic information can improve diagnostic efficiency and accuracy. However, such data continue to be misused or underutilized, which can lead to misdiagnoses and negative patient outcomes. The aim of the current review is to create an easily accessible and comprehensive reference of existing age of onset as well as prevalence and incidence data for common neurodegenerative and psychiatric disorders in adults. Relevant epidemiological data were compiled from well-respected and frequently-cited textbooks and scholarly studies. Reviews were collected from PubMed, and publicly-available sources were gathered from Google Scholar. Results are organized and presented in several tables and a figure, which can be used as a diagnostic guide for students and clinicians across healthcare disciplines.
Collapse
|
6
|
Odland AP, Lammy AB, Perle JG, Martin PK, Grote CL. Reaffirming normal: the high risk of pathologizing healthy adults when interpreting the MMPI-2-RF. Clin Neuropsychol 2015; 29:38-52. [PMID: 25643047 DOI: 10.1080/13854046.2015.1005675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Monte Carlo simulations were utilized to determine the proportion of the normal population expected to have scale elevations on the MMPI-2-RF when multiple scores are interpreted. Results showed that when all 40 MMPI-2-RF scales are simultaneously considered, approximately 70% of normal adults are likely to have at least one scale elevation at or above 65 T, and as many as 20% will have five or more elevated scales. When the Restructured Clinical (RC) Scales are under consideration, 34% of normal adults have at least one elevated score. Interpretation of the Specific Problem Scales and Personality Psychopathology Five Scales--Revised also yielded higher than expected rates of significant scores, with as many as one in four normal adults possibly being miscategorized as having features of a personality disorder by the latter scales. These findings are consistent with the growing literature on rates of apparently abnormal scores in the normal population due to multiple score interpretation. Findings are discussed in relation to clinical assessment, as well as in response to recent work suggesting that the MMPI-2-RF's multiscale composition does not contribute to high rates of elevated scores.
Collapse
Affiliation(s)
- Anthony P Odland
- a Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
| | | | | | | | | |
Collapse
|
7
|
Merckelbach H, Jelicic M, Pieters M. Misinformation increases symptom reporting: a test - retest study. JRSM SHORT REPORTS 2011; 2:75. [PMID: 22046494 PMCID: PMC3205557 DOI: 10.1258/shorts.2011.011062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objectives We examined whether misleading information (i.e. misinformation) may promote symptom reporting in non-clinical participants. Design A test–retest study in which we collected baseline data about participants' psychological symptoms and then misinformed them that they had rated two target symptoms relatively highly. During an interview, we determined whether participants would notice this misinformation and at direct and one-week follow-up, we evaluated whether the misinformation would exacerbate retest measures of the same symptoms. Setting A psychological laboratory. Participants A total of 78 undergraduate students. Main outcome measures Participants' scores on a widely used self-report measure of psychological symptoms. Results We found that most participants (63%) were blind to the discrepancies between their original symptom ratings and the upgraded scores they were misinformed with. Furthermore, at the one-week follow-up retest, blind participants revised their symptom ratings in the direction of the misinformation (i.e. they increased their ratings of these symptoms). Conclusion Introspective monitoring of common psychological symptoms is poor and this creates an opportunity for misinformation and symptom escalation. Our finding bears relevance to theories about the iatrogenic amplification of medically unexplained symptoms.
Collapse
Affiliation(s)
- Harald Merckelbach
- Faculty of Psychology and Neuroscience, Maastricht University , PO Box 616, 6200 MD, Maastricht , The Netherlands
| | | | | |
Collapse
|