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Wada-Isoe K, Kikuchi T, Umeda-Kameyama Y, Mori T, Akishita M, Nakamura Y. ABC Dementia Scale Classifies Alzheimer's Disease Patients into Subgroups Characterized by Activities of Daily Living, Behavioral and Psychological Symptoms of Dementia, and Cognitive Function. J Alzheimers Dis 2020; 73:383-392. [PMID: 31771061 PMCID: PMC7029317 DOI: 10.3233/jad-190767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/27/2022]
Abstract
The course of Alzheimer's disease (AD) varies between individuals, and the relationship between cognitive and functional decline and the deterioration of behavioral and psychological symptoms of dementia (BPSD) is still poorly understood. Until recently, it was challenging to monitor subsequent changes in these symptoms because there was no single composite scale available that could simultaneously evaluate activities of daily living (ADL), BPSD, and cognitive function (CF) states. The present authors developed a new, brief assessment scale, the "ABC Dementia Scale" (ABC-DS), which is based on item response theory and facilitates concurrent measurement of ADL, BPSD, and CF states. We previously presented the reliability, construct validity, concurrent validity, and responsiveness of the ABC-DS. We obtained the evidence through three clinical trials featuring 1,400 subjects in total. In the present study, we performed a secondary analysis of the data obtained in the previous study. We conducted hierarchical cluster analyses that allowed us to classify 197 AD patients in terms of similarities regarding ADL, BPSD, and CF domain scores, as measured by the ABC-DS. Consequently, the scale identified subgroups of patients with global clinical dementia ratings of 1, 2, and 3. Considering our results in conjunction with the clinical experiences of the AD expert among the present authors regarding longitudinal changes in ADL, BPSD, and CF, we were able to propose potential progression pathways of AD in the form of a hypothetical roadmap.
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Affiliation(s)
- Kenji Wada-Isoe
- Department of Dementia Research, Kawasaki Medical School, Kita-ku, Okayama, Japan
| | - Takashi Kikuchi
- Translational Research Informatics Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe, Chuo-ku Kobe, Hyogo, Japan
| | - Yumi Umeda-Kameyama
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takahiro Mori
- Department of Neuropsychiatry, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yu Nakamura
- Department of Neuropsychiatry, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
| | - on behalf of the ABC Dementia Scale Research Group
- Department of Dementia Research, Kawasaki Medical School, Kita-ku, Okayama, Japan
- Translational Research Informatics Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe, Chuo-ku Kobe, Hyogo, Japan
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Neuropsychiatry, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
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Vila-Castelar C, Ly JJ, Kaplan L, Van Dyk K, Berger JT, Macina LO, Stewart JL, Foldi NS. Attention Measures of Accuracy, Variability, and Fatigue Detect Early Response to Donepezil in Alzheimer's Disease: A Randomized, Double-blind, Placebo-Controlled Pilot Trial. Arch Clin Neuropsychol 2019; 34:277-289. [PMID: 29635383 PMCID: PMC6487534 DOI: 10.1093/arclin/acy032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/03/2018] [Accepted: 03/20/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Donepezil is widely used to treat Alzheimer's disease (AD), but detecting early response remains challenging for clinicians. Acetylcholine is known to directly modulate attention, particularly under high cognitive conditions, but no studies to date test whether measures of attention under high load can detect early effects of donepezil. We hypothesized that load-dependent attention tasks are sensitive to short-term treatment effects of donepezil, while global and other domain-specific cognitive measures are not. METHOD This longitudinal, randomized, double-blind, placebo-controlled pilot trial (ClinicalTrials.gov Identifier: NCT03073876) evaluated 23 participants newly diagnosed with AD initiating de novo donepezil treatment (5 mg). After baseline assessment, participants were randomized into Drug (n = 12) or Placebo (n = 11) groups, and retested after approximately 6 weeks. Cognitive assessment included: (a) attention tasks (Foreperiod Effect, Attentional Blink, and Covert Orienting tasks) measuring processing speed, top-down accuracy, orienting, intra-individual variability, and fatigue; (b) global measures (Alzheimer's Disease Assessment Scale-Cognitive Subscale, Mini-Mental Status Examination, Dementia Rating Scale); and (c) domain-specific measures (memory, language, visuospatial, and executive function). RESULTS The Drug but not the Placebo group showed benefits of treatment at high-load measures by preserving top-down accuracy, improving intra-individual variability, and averting fatigue. In contrast, other global or cognitive domain-specific measures could not detect treatment effects over the same treatment interval. CONCLUSIONS The pilot-study suggests that attention measures targeting accuracy, variability, and fatigue under high-load conditions could be sensitive to short-term cholinergic treatment. Given the central role of acetylcholine in attentional function, load-dependent attentional measures may be valuable cognitive markers of early treatment response.
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Affiliation(s)
- Clara Vila-Castelar
- Department of Psychology, Queens College and The Graduate Center, City University of New York, New York, NY, USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jenny J Ly
- eResearch Technology, Inc., Boston, MA, USA
| | - Lillian Kaplan
- Department of Occupational Therapy, York College, City University of New York, New York, NY, USA
| | - Kathleen Van Dyk
- Department of Psychiatry, UCLA - Semel Institute for Neuroscience & Human Behavior and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Jeffrey T Berger
- Division of Palliative Medicine and Bioethics, Department of Medicine, NYU Winthrop Hospital, Mineola, NY, USA
| | - Lucy O Macina
- Division of Geriatrics, Department of Medicine, NYU Winthrop Hospital, Mineola, NY, USA
| | - Jennifer L Stewart
- Department of Psychology, Queens College and The Graduate Center, City University of New York, New York, NY, USA
| | - Nancy S Foldi
- Department of Psychology, Queens College and The Graduate Center, City University of New York, New York, NY, USA
- Division of Geriatrics, Department of Medicine, NYU Winthrop Hospital, Mineola, NY, USA
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Park JJ, Choi SH, Kim S, Lee AY, Moon SY, Lee JH, Kwon JC, Park KW, Ku BD, Han HJ, Kim EJ, Shim YS. Effect of galantamine on attention in patients with Alzheimer's disease combined with cerebrovascular disease. Geriatr Gerontol Int 2016; 17:1661-1666. [PMID: 27935239 DOI: 10.1111/ggi.12934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/14/2016] [Accepted: 09/22/2016] [Indexed: 12/01/2022]
Abstract
AIM Patients with Alzheimer's disease (AD) and cerebrovascular disease (CVD) show greater attentional deficits compared with AD patients without CVD. The aim of the present study was to investigate the effect of galantamine on attention in AD patients with CVD. METHODS In this open trial, 1512 patients with AD and CVD were recruited from 71 nationwide hospitals. The patients were given galantamine for 16 weeks. The primary outcome measure was the score on the Attention Questionnaire Scale (AQS), which measures the patients' attention in their daily lives. The secondary outcome measures were the scores on the Korean Mini-Mental State Examination, the Clinical Dementia Rating scale and the Global Deterioration Scale. Efficacy measures were calculated both at baseline and at the end of the treatment (week 16). RESULTS The responders rate on the AQS (change of the AQS from baseline >0) was 60.6% in AD patients with CVD. At the end of the treatment, both the AQS (15.0 ± 5.7 vs 16.3 ± 5.8, P < 0.001) and the Korean Mini-Mental State Examination scores (17.8 ± 4.8 vs 18.1 ± 5.1, P < 0.001) showed a significant improvement relative to the baseline performance. The Clinical Dementia Rating (1.25 ± 0.59 vs 1.22 ± 0.63 P = 0.025) and Global Deterioration Scale (3.82 ± 0.94 vs 3.76 ± 0.96, P = 0.002) scores also showed a significant decrease at the end of the treatment. CONCLUSIONS Galantamine is effective in improving attention in the daily lives of AD patients with CVD. Geriatr Gerontol Int 2017; 17: 1661-1668.
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Affiliation(s)
- Jeong Jin Park
- Department of Neurology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Ae Young Lee
- Department of Neurology, Chungnam National University School of Medicine, Daejeon, Korea
| | - So Young Moon
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Jun Hong Lee
- Department of Neurology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Jae Cheol Kwon
- Department of Neurology, Changwon Fatima Hospital, Changwon, Korea
| | - Kyung Won Park
- Department of Neurology, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Bon D Ku
- Department of Neurology, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Hyun Jeong Han
- Department of Neurology, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea
| | - Yong S Shim
- Department of Neurology, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
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Borges SDM, Radanovic M, Forlenza OV. Correlation between functional mobility and cognitive performance in older adults with cognitive impairment. AGING NEUROPSYCHOLOGY AND COGNITION 2016; 25:23-32. [PMID: 27934540 DOI: 10.1080/13825585.2016.1258035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Association between cognitive impairment and gait performance occurs in mild cognitive impairment (MCI) and Alzheimer's disease (AD), particularly under "divided attention" conditions, leading to a greater risk of falls. We studied 36 controls, 42 MCI, and 26 mild AD patients, using the Timed Up-and-Go test (TUG) under four conditions: TUG single - TUG1; TUG cognitive - TUG2; TUG manual -TUG3; TUG cognitive and manual - TUG4. Cognition was assessed using the MMSE, SKT, Exit25, and TMT (A and B). We found significant correlations between cognitive scores and TUG2 [r values (MMSE: -0.383, TMT-A: 0.430, TMT-B: 0.386, Exit25: 0.455, SKT: 0.563)] and TUG4 [(MMSE: -0.398, TMT-A: 0.384, TMT-B: 0.352,Exit25: 0.466, SKT: 0.525)] in the AD group, and between all TUG modalities and SKT in MCI and AD. Our results revealed that functional mobility impairment in cognitive dual tasks correlated to cognitive decline in AD patients and to attention and memory impairment in MCI.
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Affiliation(s)
- Sheila de Melo Borges
- a Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine , University of São Paulo , São Paulo , Brazil.,b Faculty of Physical Therapy , Santa Cecilia University , Santos , Brazil
| | - Márcia Radanovic
- a Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine , University of São Paulo , São Paulo , Brazil
| | - Orestes Vicente Forlenza
- a Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine , University of São Paulo , São Paulo , Brazil
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Lee J, Choi BH, Oh E, Sohn EH, Lee AY. Treatment of Alzheimer's Disease with Repetitive Transcranial Magnetic Stimulation Combined with Cognitive Training: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study. J Clin Neurol 2015; 12:57-64. [PMID: 26365021 PMCID: PMC4712287 DOI: 10.3988/jcn.2016.12.1.57] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Repetitive transcranial magnetic stimulation (rTMS) has been examined as a potential treatment for many neurological disorders. High-frequency rTMS in particular improves cognitive functions such as verbal fluency and memory. This study explored the effect of rTMS combined with cognitive training (rTMS-COG) on patients with Alzheimer's disease (AD). METHODS A prospective, randomized, double-blind, placebo-controlled study was performed with 27 AD patients (18 and 8 in the treatment and sham groups, respectively, and 1 drop-out). The participants were categorized into mild [Mini-Mental State Examination (MMSE) score=21-26] and moderate (MMSE score=18-20) AD groups. The rTMS protocols were configured for six cortical areas (both dorsolateral prefrontal and parietal somatosensory associated cortices and Broca's and Wernicke's areas; 10 Hz, 90-110% intensity, and 5 days/week for 6 weeks). Neuropsychological assessments were performed using the AD Assessment Scale-cognitive subscale (ADAS-cog), Clinical Global Impression of Change (CGIC), and MMSE before, immediately after, and 6 weeks after the end of rTMS-COG treatment. RESULTS Data from 26 AD patients were analyzed in this study. There was no significant interactive effect of time between the groups. The ADAS-cog score in the treatment group was significantly improved compared to the sham group (4.28 and 5.39 in the treatment group vs. 1.75 and 2.88 in the sham group at immediately and 6 weeks after treatment, respectively). The MMSE and CGIC scores were also improved in the treatment group. Based on subgroup analysis, the effect of rTMS-COG was superior for the mild group compared to the total patients, especially in the domains of memory and language. CONCLUSIONS The present results suggest that rTMS-COG represents a useful adjuvant therapy with cholinesterase inhibitors, particularly during the mild stage of AD. The effect of rTMS-COG was remarkable in the memory and language domains, which are severely affected by AD.
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Affiliation(s)
- Juyoun Lee
- Department of Neurology, Cognitive Neuroscience Section, Chungnam National University Hospital, Daejeon, Korea
| | - Byong Hee Choi
- Cognitive Neuroscience Section, Chungnam National University Hospital, Daejeon, Korea
| | - Eungseok Oh
- Department of Neurology, Cognitive Neuroscience Section, Chungnam National University Hospital, Daejeon, Korea
| | - Eun Hee Sohn
- Department of Neurology, Cognitive Neuroscience Section, Chungnam National University Hospital, Daejeon, Korea
| | - Ae Young Lee
- Department of Neurology, Cognitive Neuroscience Section, Chungnam National University Hospital, Daejeon, Korea.,Cognitive Neuroscience Section, Chungnam National University Hospital, Daejeon, Korea.
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