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Custodio N, Malaga M, Montesinos R, Chambergo-Michilot D, Baca F, Carbajal JC, Huilca JC, Herrera-Perez E, Lira D, Diaz MM, Lanata S. The Memory Alteration Test Is Correlated with Clinical, Cerebrospinal Fluid, and Brain Imaging Markers of Alzheimer Disease in Lima, Peru. Dement Geriatr Cogn Disord 2023; 52:309-317. [PMID: 37827146 PMCID: PMC11214699 DOI: 10.1159/000534157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/04/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION As disease-modifying therapies become available for Alzheimer's disease (AD), detection of AD in early stages of illness (mild cognitive impairment [MCI], early dementia) becomes increasingly important. Biomarkers for AD in low- and middle-income countries (LMICs) are costly and not widely available; hence, it is important to identify cognitive tests that correlate well with AD biomarker status. In this study, we evaluated the memory alteration test (M@T) to detect biomarker-proven AD and quantify its correlation with neurodegeneration and cerebrospinal fluid (CSF) AD biomarkers in a cohort of participants from Lima, Peru. METHODS This is a secondary analysis of a cohort of 185 participants: 63 controls, 53 with amnestic MCI (aMCI), and 69 with dementia due to AD. Participants underwent testing with M@T and a gold standard neuropsychological battery. We measured total tau (t-tau), phosphorylated tau (p-tau), and beta-amyloid (β-amyloid) in CSF, and evaluated neurodegeneration via medial temporal atrophy score in MRI. We used receiver-operator curves to determine the discriminative capacity of the total M@T score and its subdomains. We used the Pearson coefficient to correlate M@T score and CSF biomarkers. RESULTS The M@T had an area under the curve (AUC) of 0.994 to discriminate between controls and cognitively impaired (aMCI or AD) patients, and an AUC of 0.98 to differentiate between aMCI and AD patients. Free-recall and cued recall had the highest AUCs of all subdomains. Total score was strongly correlated with t-tau (-0.77) and p-tau (-0.72), and moderately correlated with β-amyloid (0.66). The AUC for discrimination of neurodegeneration was 0.87. CONCLUSION The M@T had excellent discrimination of aMCI and dementia due to AD. It was strongly correlated with CSF biomarkers and had good discrimination of neurodegeneration. In LMICs, the M@T may be a cost-effective screening tool for aMCI and dementia caused by AD.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
| | - Marco Malaga
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru,
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, California, USA,
- Grupo de Investigación Neurociencia Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru,
| | - Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Diego Chambergo-Michilot
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
| | - Fiorella Baca
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru
| | - Juan Carlos Carbajal
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Jose Carlos Huilca
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Monica M Diaz
- Department of Neurology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Serggio Lanata
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, California, USA
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Montesinos R, Parodi JF, Diaz MM, Herrera-Perez E, Valeriano-Lorenzo E, Soto A, Delgado C, Slachevsky A, Custodio N. Validation of Picture Free and Cued Selective Reminding Test for Illiteracy in Lima, Peru. Am J Alzheimers Dis Other Demen 2022; 37:15333175221094396. [PMID: 35465730 PMCID: PMC10581140 DOI: 10.1177/15333175221094396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dementia in Latin America is a crucial public health problem. Identifying brief cognitive screening (BCS) tools for the primary care setting is crucial, particularly for illiterate individuals. We evaluated tool performance characteristics and validated the free and total recall sections of the Free and Cued Selective Reminding Test-Picture version (FCSRT-Picture) to discriminate between 63 patients with early Alzheimer's disease dementia (ADD), 60 amnestic mild cognitive impairment (aMCI) and 64 cognitively healthy Peruvian individuals with illiteracy from an urban area. Clinical, functional, and cognitive assessments were performed. FCSRT-Picture performance was assessed using receiver operating characteristic curve analyses. The mean ± standard deviation scores were 7.7 ± 1.0 in ADD, 11.8 ± 1.6 in aMCI, and 29.5 ± 1.8 in controls. The FCSRT-Picture had better performance characteristics for distinguishing controls from aMCI compared with several other BCS tools, but similar characteristics between controls and early ADD. The FCSRT-Picture is a reliable BCS tool for illiteracy in Peru.
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Affiliation(s)
- Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
| | - Jose F. Parodi
- Centro de Investigación del Envejecimiento, Facultad de Medicina, Universidad de San Martín de Porres, Lima, Perú
| | - Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Eder Herrera-Perez
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Grupo de Investigación Molident, Universidad San Ignacio de Loyola, Lima, Perú
| | - Elizabeth Valeriano-Lorenzo
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Faculty of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Ambar Soto
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Carolina Delgado
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago, Chile
- Departamento de neurociencia, Facultad de medicina Universidad de Chile, Santiago, Chile
| | - Andrea Slachevsky
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department, ICBM, Neurosciences and East Neuroscience Departments, University of Chile School of Medicine, Santiago, Chile
- Geroscience Center for Brain Health and Metabolism (GERO), University of Chile School of Medicine, Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN), Neurology Department, Del Salvador Hospital and University of Chile School of Medicine, Santiago, Chile
- Neurology Unit, Department of Medicine, Alemana Clinic, Universidad del Desarrollo, Santiago, Chile
| | - Nilton Custodio
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Perú
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Custodio N, Montesinos R, Cruzado L, Herrera-Perez E, Failoc-Rojas VE, Pintado-Caipa M, Seminario G W, Cuenca J, Gamboa C, Diaz MM. Social Cognition and Behavioral Assessments Improve the Diagnosis of Behavioral Variant of Frontotemporal Dementia in Older Peruvians With Low Educational Levels. Front Neurol 2021; 12:704109. [PMID: 34552551 PMCID: PMC8450322 DOI: 10.3389/fneur.2021.704109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The behavioral variant of frontotemporal dementia (bvFTD), characterized by early behavioral abnormalities and late memory impairment, is a neurodegenerative disorder with a detrimental impact on patients and their caregivers. bvFTD is often difficult to distinguish from other neurodegenerative diseases, such as Alzheimer's disease (AD), using brief cognitive tests. Combining brief socio-cognitive and behavioral evaluations with standard cognitive testing could better discriminate bvFTD from AD patients. We sought to evaluate the diagnostic accuracy of brief socio-cognitive tests that may differentiate bvFTD and AD patients with low educational levels. Methods: A prospective study was performed on 51 individuals over the age of 50 with low educational levels, with bvFTD or AD diagnosed using published criteria, and who were receiving neurological care at a multidisciplinary neurology clinic in Lima, Peru, between July 2017 and December 2020. All patients had a comprehensive neurological evaluation, including a full neurocognitive battery and brief tests of cognition (Addenbrooke's Cognitive Examination version III, ACE-III), social cognition (Mini-social Cognition and Emotional Assessment, Mini-SEA), and behavioral assessments (Frontal Behavioral Inventory, FBI; Interpersonal Reactivity Index-Emphatic Concern, IRI-EC; IRI-Perspective Taking, IRI-PT; and Self-Monitoring Scale-revised version, r-SMS). Receiver operating characteristic (ROC) analysis to calculate the area under the curve (AUC) was performed to compare the brief screening tests individually and combined to the gold standard of bvFTD and AD diagnoses. Results: The AD group was significantly older than the bvFTD group (p < 0.001). An analysis of the discriminatory ability of the ACE-III to distinguish between patients with AD and bvFTD (AUC = 0.85) and the INECO Frontal Screening (IFS; AUC = 0.78) shows that the former has greater discriminatory ability. Social and behavioral cognition tasks were able to appropriately discriminate bvFTD from AD. The Mini-SEA had high sensitivity and high moderate specificity (83%) for discriminating bvFTD from AD, which increased when combined with the brief screening tests ACE-III and IFS. The FBI was ideal with high sensitivity (83%), as well as the IRI-EC and IRI-PT that also were adequate for distinguishing bvFTD from AD. Conclusions: Our study supports the integration of socio-behavioral measures to the standard global cognitive and social cognition measures utilized for screening for bvFTD in a population with low levels of education.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lizardo Cruzado
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Instituto Nacional de Salud Mental “Honorio Delgado—Hideyo Noguchi”, Lima, Peru
- Grupo de investigación Molident, Universidad San Ignacio de Loyola, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Virgilio E. Failoc-Rojas
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
| | - Maritza Pintado-Caipa
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Atlantic Fellow, Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Wendy Seminario G
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
| | - José Cuenca
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
- Carrera de Psicología, Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru
| | - Carlos Gamboa
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
| | - Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
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