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Claus CC, Staekenborg SS, Verweij KHW, Schuur J, van der Werf SP, Scheltens P, Claus JJ. The clock drawing test is an important contribution to the Mini Mental State Examination in screening for cognitive impairment. Int J Geriatr Psychiatry 2023; 38:e5914. [PMID: 37083937 DOI: 10.1002/gps.5914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND The clock drawing test (CDT) and the Mini Mental State Examination (MMSE) are frequently used screening instruments for cognitive impairment, however, the precise contribution of the CDT to the MMSE is largely unknown. METHODS We studied patients with subjective cognitive impairment (SCI, n = 481), mild cognitive impairment (MCI, n = 628) and Alzheimer's disease (AD, n = 1099). Discrimination between patients was examined with multiple logistic regression, adjusted for age, sex, and education. Four groups were constructed based on a normal/abnormal MMSE (cut-off <24/30) versus normal/abnormal CDT (cut-off ≤2/3). Visually rated medial temporal lobe atrophy (MTA) on CT was used as parameter of neurodegeneration. RESULTS The CDT significantly contributed to the MMSE in discriminating SCI from both MCI and AD patients. Our four group analyses showed that of those patients with a normal MMSE and incorrectly classified as SCI, an abnormal CDT could significantly identify 10.0% as MCI and 13.2% as AD. Among those with an abnormal MMSE, the percentage AD patients shifted from 53.1% to 82.1% due to an abnormal CDT. Presence of an abnormal CDT was significantly related to MTA increase, regardless of the MMSE score. CONCLUSION The CDT is an important additional screening tool to the MMSE. An abnormal CDT with a normal MMSE is an indicator for cognitive impairment. An abnormal CDT in combination with an abnormal MMSE can be considered as an indicator of disease progression.
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Affiliation(s)
- Caroline C Claus
- Department of Neurology, Tergooi Medical Center, Hilversum, The Netherlands
- Department of Medical Psychology, Tergooi Medical Center, Hilversum, The Netherlands
| | | | - Kim H W Verweij
- Department of Medical Psychology, Tergooi Medical Center, Hilversum, The Netherlands
| | - Jacqueline Schuur
- Department of Geriatrics, Tergooi Medical Center, Hilversum, The Netherlands
| | - Sieberen P van der Werf
- Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jules J Claus
- Department of Neurology, Tergooi Medical Center, Hilversum, The Netherlands
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2
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Fruijtier AD, Visser LN, Bouwman FH, Lutz R, Schoonenboom N, Kalisvaart K, Hempenius L, Roks G, Boelaarts L, Claus JJ, Kleijer M, de Beer M, van der Flier WM, Smets EM. What patients want to know, and what we actually tell them: The ABIDE project. Alzheimers Dement (N Y) 2020; 6:e12113. [PMID: 33344753 PMCID: PMC7744024 DOI: 10.1002/trc2.12113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND We studied to what degree and at whose initiative 25 informational topics, formerly identified as important, are discussed in diagnostic consultations. METHODS Audio recordings of clinician-patient consultations of 71 patients and 32 clinicians, collected in eight Dutch memory clinics, were independently content-coded by two coders. The coding scheme encompassed 25 informational topics. RESULTS Approximately half (Mdn = 12) of the 25 topics were discussed per patient during the diagnostic process, with a higher frequency among individuals receiving a dementia diagnosis (Mdn = 14) compared to others (Mdn = 11). Individual topics ranged from being discussed with 2/71 (3%) to 70/71 (99%) of patients. Patients and/or care partners rarely initiated topic discussion (10%). When they did, they often enquired about one of the least frequently addressed topics. CONCLUSION Most patients received information on approximately half of the important informational topics. Providing the topic list to patients and care partners beforehand could allow consultation preparation and stimulate participation.
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Affiliation(s)
- Agnetha D. Fruijtier
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
- Department of Medical PsychologyAcademic Medical CenterAmsterdam UMCAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - Leonie N.C. Visser
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
- Department of Medical PsychologyAcademic Medical CenterAmsterdam UMCAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - Femke H. Bouwman
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Rogier Lutz
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Niki Schoonenboom
- Department of Clinical GeriatricsSpaarne GasthuisHaarlemthe Netherlands
| | - Kees Kalisvaart
- Department of Clinical GeriatricsSpaarne GasthuisHaarlemthe Netherlands
| | | | - Gerwin Roks
- Department of NeurologyETZ HospitalTilburgthe Netherlands
| | - Leo Boelaarts
- Geriatric DepartmentNoordWest Ziekenhuis GroepAlkmaarthe Netherlands
| | - Jules J. Claus
- Department of NeurologyTergooi Hospital, Blaricumthe Netherlands
| | - Mariska Kleijer
- Department of NeurologyLangeLand ZiekenhuisZoetermeerthe Netherlands
| | - Marlijn de Beer
- Department of NeurologyReinier de Graaf GasthuisDelftthe Netherlands
| | - Wiesje M. van der Flier
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam NeuroscienceVU University Medical CenterAmsterdamthe Netherlands
| | - Ellen M.A. Smets
- Department of Medical PsychologyAcademic Medical CenterAmsterdam UMCAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
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3
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Fruijtier AD, Visser LNC, Bouwman F, Lutz R, Schoonenboom NSM, Kalisvaart K, Hempenius L, Roks G, Boelaarts L, Claus JJ, Kleijer M, Beer M, van Der Flier W, Smets EM. What patients want to know, and what we actually tell them: The ABIDE project. Alzheimers Dement 2020. [DOI: 10.1002/alz.044754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Agnetha D Fruijtier
- Alzheimer Center Amsterdam Department of Neurology Amsterdam Neuroscience Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam Netherlands
- Alzheimer Center Amsterdam Amsterdam Netherlands
| | - Leonie NC Visser
- Department of Medical Psychology Amsterdam Public Health research Institute University of Amsterdam, Amsterdam UMC Amsterdam Netherlands
| | - Femke Bouwman
- Alzheimer Center Amsterdam Department of Neurology Amsterdam Neuroscience Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam Netherlands
| | - Rogier Lutz
- Alzheimer Center Amsterdam Amsterdam Netherlands
| | | | - Kees Kalisvaart
- Spaarne Gasthuis, Dep of Geriatric Medicine Haarlem Netherlands
| | | | - Gerwin Roks
- Elisabeth‐TweeSteden Ziekenhuis Tilburg Netherlands
| | - Leo Boelaarts
- Department of Geriatric Medicine Noordwest Hospital Group Alkmaar Netherlands
| | | | - Mariska Kleijer
- Department of Neurology LangeLand Ziekenhuis Zoetermeer Netherlands
| | - Marlijn Beer
- Department of Neurology Reinier de Graaf Gasthuis Delft Netherlands
| | - Wiesje van Der Flier
- Alzheimer Center Amsterdam, Amsterdam Neuroscience Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam Netherlands
| | - Ellen M Smets
- Department of Medical Psychology Amsterdam Public Health research Institute University of Amsterdam, Amsterdam UMC Amsterdam Netherlands
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4
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Staekenborg SS, Kelly N, Schuur J, Koster P, Scherder E, Tielkes CE, Scheltens P, Claus JJ. Education as Proxy for Cognitive Reserve in a Large Elderly Memory Clinic: ‘Window of Benefit’. J Alzheimers Dis 2020; 76:671-679. [DOI: 10.3233/jad-191332] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
| | - Naomi Kelly
- Department of Medical Psychology, Neuroscience Campus Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jacqueline Schuur
- Department of Geriatrics, Tergooi Hospital, Blaricum, The Netherlands
| | - Pieter Koster
- Department of Radiology, Tergooi Hospital, Blaricum, The Netherlands
| | - Erik Scherder
- Department of Medical Psychology, Neuroscience Campus Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Philip Scheltens
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jules J. Claus
- Department of Neurology, Tergooi Hospital, Blaricum, The Netherlands
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5
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Visser LNC, Pelt SAR, Kunneman M, Bouwman FH, Claus JJ, Kalisvaart KJ, Hempenius L, de Beer MH, Roks G, Boelaarts L, Kleijer M, van der Flier WM, Smets EMA, Hillen MA. Communicating uncertainties when disclosing diagnostic test results for (Alzheimer's) dementia in the memory clinic: The ABIDE project. Health Expect 2019; 23:52-62. [PMID: 31638322 PMCID: PMC6978856 DOI: 10.1111/hex.12964] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 02/06/2023] Open
Abstract
Background The development of novel diagnostics enables increasingly earlier diagnosis of Alzheimer's disease (AD). Timely diagnosis may benefit patients by reducing their uncertainty regarding the cause of symptoms, yet does not always provide patients with the desired certainty. Objective To examine, using both quantitative and qualitative methods, uncertainty communicated by memory clinic clinicians in post‐diagnostic testing consultations with patients and their caregivers. Methods First, we identified all uncertainty expressions of 22 clinicians in audiotaped post‐diagnostic testing consultations with 78 patients. Second, we statistically explored relationships between patient/clinician characteristics and uncertainty expressions. Third, the transcribed uncertainty expressions were qualitatively analysed, determining the topic to which they pertained, their source and initiator/elicitor (clinicians/patients/caregivers). Results Within 57/78 (73%) consultations, clinicians expressed in total 115 uncertainties, of which 37% elicited by the patient or caregiver. No apparent relationships were found between patient/clinician characteristics and whether or not, and how often clinicians expressed uncertainty. Uncertainty expressions pertained to ten different topics, most frequently patient's diagnosis and symptom progression. Expressed uncertainty was mostly related to the unpredictability of the future and limits to available knowledge. Discussion and conclusions The majority of clinicians openly discussed the limits of scientific knowledge and diagnostic testing with patients and caregivers in the dementia context. Noticeably, clinicians did not discuss uncertainty in about one quarter of consultations. More evidence is needed on the beneficial and/or harmful effects on patients of discussing uncertainty with them. This knowledge can be used to support clinicians to optimally convey uncertainty and facilitate patients' uncertainty management.
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Affiliation(s)
- Leonie N C Visser
- Department of Medical Psychology, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sophie A R Pelt
- Department of Medical Psychology, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marleen Kunneman
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA.,Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Femke H Bouwman
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jules J Claus
- Department of Neurology, Tergooi Hospital, Blaricum, The Netherlands
| | - Kees J Kalisvaart
- Department of Clinical Geriatrics, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Liesbeth Hempenius
- Geriatric Center, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Marlijn H de Beer
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Gerwin Roks
- Department of Neurology, ETZ Hospital, Tilburg, The Netherlands
| | - Leo Boelaarts
- Geriatric Department, NoordWest Ziekenhuis Groep, Alkmaar, The Netherlands
| | - Mariska Kleijer
- Department of Neurology, LangeLand Ziekenhuis, Zoetermeer, The Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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6
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Willemse EA, van Maurik IS, Tijms BM, Bouwman FH, Franke A, Hubeek I, Boelaarts L, Claus JJ, Korf ES, van Marum RJ, Roks G, Schoonenboom N, Verwey N, Zwan MD, Wahl S, van der Flier WM, Teunissen CE. Diagnostic performance of Elecsys immunoassays for cerebrospinal fluid Alzheimer's disease biomarkers in a nonacademic, multicenter memory clinic cohort: The ABIDE project. Alzheimers Dement (Amst) 2018; 10:563-572. [PMID: 30406175 PMCID: PMC6215060 DOI: 10.1016/j.dadm.2018.08.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction We compared the automated Elecsys and manual Innotest immunoassays for cerebrospinal fluid (CSF) Alzheimer's disease biomarkers in a multicenter diagnostic setting. Methods We collected CSF samples from 137 participants in eight local memory clinics. Amyloid β(1–42) (Aβ42), total tau (t-tau), and phosphorylated tau (p-tau) were centrally analyzed with Innotest and Elecsys assays. Concordances between methods were assessed. Results Biomarker results strongly correlated between assays with Spearman's ρ 0.94 for Aβ42, 0.98 for t-tau, and 0.98 for p-tau. Using Gaussian mixture modeling, cohort-specific cut-points were estimated at 1092 pg/mL for Aβ42, 235 pg/mL for t-tau, and 24 pg/mL for p-tau. We found an excellent concordance of biomarker abnormality between assays of 97% for Aβ42 and 96% for both t-tau and p-tau. Discussion The high concordances between Elecsys and Innotest in this nonacademic, multicenter cohort support the use of Elecsys for CSF Alzheimer's disease diagnostics and allow conversion of results between methods. Method comparison of 137 CSF samples collected in eight nonacademic memory clinics. Innotest and Elecsys strongly correlated: ρ = 0.94 Aβ42; 0.98 t-tau; 0.98 p-tau. Concordances of biomarker abnormalities: 97% Aβ42; 96% t-tau and p-tau. Concordance of NIA-AA–based Alzheimer's disease profile (Aβ42 decreased and p-tau increased): 89%. Preanalytical protocol deviations did not show effects on biomarker correlations.
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Affiliation(s)
- Eline A.J. Willemse
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Corresponding author. Tel.: +31-20-44-43029; Fax: +31-20-44-43857.
| | - Ingrid S. van Maurik
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Betty M. Tijms
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Femke H. Bouwman
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Isabelle Hubeek
- Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Leo Boelaarts
- Department of Geriatric Medicine, Noordwest Hospital Group, Alkmaar, The Netherlands
| | - Jules J. Claus
- Department of Neurology, Tergooi Hospital, Hilversum, The Netherlands
| | - Esther S.C. Korf
- Department of Neurology, Admiraal De Ruyter Hospital, Goes, The Netherlands
| | - Rob J. van Marum
- Department of Geriatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
- Department of Family Medicine and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gerwin Roks
- Department of Neurology, Elisabeth Tweesteden Hospital (ETZ), Tilburg, The Netherlands
| | | | - Nicolaas Verwey
- Department of Neurology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Marissa D. Zwan
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Wiesje M. van der Flier
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Charlotte E. Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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de Brouwer EJM, Kockelkoren R, Claus JJ, de Jonghe A, Geerlings MI, Jongsma TEF, Mali WPTM, Hendrikse J, de Jong PA, Koek HL. Hippocampal Calcifications: Risk Factors and Association with Cognitive Function. Radiology 2018; 288:815-820. [DOI: 10.1148/radiol.2018172588] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Willemse EA, Maurik IS, Tijms BM, Franke A, Hubeek I, Boelaarts L, Claus JJ, Korf ES, Van Marum RJ, Roks G, Schoonenboom NS, Verwey N, Wahl S, Flier WM, Teunissen CE. O2‐09‐03: DIAGNOSTIC PERFORMANCE OF ELECSYS IMMUNOASSAYS FOR CEREBROSPINAL FLUID ALZHEIMER'S DISEASE BIOMARKERS IN A NON‐ACADEMIC MULTICENTER MEMORY CLINIC COHORT: THE ABIDE PROJECT. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Eline A.J. Willemse
- Alzheimer Center & Department of Neurology, Amsterdam NeuroscienceVU University Medical CenterAmsterdamNetherlands
- Neurochemistry Lab, Clinical ChemistryVU University Medical CenterAmsterdamNetherlands
| | - Ingrid S. Maurik
- Alzheimer Center and Department of Neurology, Amsterdam NeuroscienceVU University Medical CenterAmsterdamNetherlands
| | - Betty M. Tijms
- Alzheimer Center & Department of Neurology, Amsterdam NeuroscienceVU University Medical CenterAmsterdamNetherlands
| | - Andreas Franke
- Triga-S e.K.HabachGermany
- Roche Diagnostics GmbHPenzbergGermany
| | | | - Leo Boelaarts
- Department of Geriatric MedicineNoordwest Hospital GroupAlkmaarNetherlands
| | | | | | | | | | | | | | | | | | - Charlotte E. Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam NeuroscienceVU University Medical CenterAmsterdamNetherlands
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Claus JJ, Coenen M, Staekenborg SS, Schuur J, Tielkes CE, Koster P, Scheltens P. Cerebral White Matter Lesions have Low Impact on Cognitive Function in a Large Elderly Memory Clinic Population. J Alzheimers Dis 2018; 63:1129-1139. [DOI: 10.3233/jad-171111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Jules J. Claus
- Department of Neurology, Tergooi Hospitals, Blaricum, The Netherlands
| | - Mirthe Coenen
- Department of Neurology, Tergooi Hospitals, Blaricum, The Netherlands
| | - Salka S. Staekenborg
- Department of Neurology, Tergooi Hospitals, Blaricum, The Netherlands
- Department of Neurology, Alzheimer Center, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Jacqueline Schuur
- Department of Geriatrics, Tergooi Hospitals, Blaricum, The Netherlands
| | | | - Pieter Koster
- Department of Radiology, Tergooi Hospitals, Blaricum, The Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
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10
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Kunneman M, Pel-Littel R, Bouwman FH, Gillissen F, Schoonenboom NSM, Claus JJ, van der Flier WM, Smets EMA. Patients' and caregivers' views on conversations and shared decision making in diagnostic testing for Alzheimer's disease: The ABIDE project. Alzheimers Dement (N Y) 2017; 3:314-322. [PMID: 29067338 PMCID: PMC5651429 DOI: 10.1016/j.trci.2017.04.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction This study aims to assess patients' and caregivers' views on and experiences with (1) decisions about diagnostic testing for Alzheimer's disease (AD) and (2) receiving test results. Methods We conducted separate focus groups with patients from three hospitals who underwent diagnostic testing for AD (N = 11) and their caregivers (N = 11). Audio recordings were transcribed verbatim and analyzed using MaxQDA. Results Patients and caregivers preferred and perceived active involvement in decision making, but the decision to initiate diagnostic testing seems to be made before the clinician-patient encounter. Patients and caregivers indicate that decisions are driven by a strong need to explain the patient's symptoms. They missed information on why different diagnostic tests were used, what the results of these tests were, and to what extent these results were (ab)normal. Discussion The decision-making process around diagnostic testing for AD and the information provision before and after diagnostic testing could be improved.
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Affiliation(s)
- Marleen Kunneman
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - Ruth Pel-Littel
- Vilans Centre of Expertise for Long-Term Care, Utrecht, The Netherlands
| | - Femke H Bouwman
- Alzheimer Center and Department of Neurology, VU University Medical Center and Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Freek Gillissen
- Alzheimer Center and Department of Neurology, VU University Medical Center and Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Jules J Claus
- Department of Neurology, Tergooi Hospital, Hilversum, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center and Department of Neurology, VU University Medical Center and Amsterdam Neuroscience, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
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11
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Claus JJ, Staekenborg SS, Holl DC, Roorda JJ, Schuur J, Koster P, Tielkes CEM, Scheltens P. Practical use of visual medial temporal lobe atrophy cut-off scores in Alzheimer's disease: Validation in a large memory clinic population. Eur Radiol 2017; 27:3147-3155. [PMID: 28083697 PMCID: PMC5491609 DOI: 10.1007/s00330-016-4726-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/06/2016] [Accepted: 12/21/2016] [Indexed: 12/19/2022]
Abstract
Objective To provide age-specific medial temporal lobe atrophy (MTA) cut-off scores for routine clinical practice as marker for Alzheimer’s disease (AD). Methods Patients with AD (n = 832, mean age 81.8 years) were compared with patients with subjective cognitive impairment (n = 333, mean age 71.8 years) in a large single-centre memory clinic. Mean of right and left MTA scores was determined with visual rating (Scheltens scale) using CT (0, no atrophy to 4, severe atrophy). Relationships between age and MTA scores were analysed with regression analysis. For various MTA cut-off scores, decade-specific sensitivity and specificity and area under the curve (AUC) values, computed with receiver operator characteristic curves, were determined. Results MTA strongly increased with age in both groups to a similar degree. Optimal MTA cut-off values for the age ranges <65, 65–74, 75–84 and ≥85 were: ≥1.0, ≥1.5, ≥ 2.0 and ≥2.0. Corresponding values of sensitivity and specificity were 83.3% and 86.4%; 73.7% and 84.6%; 73.7% and 76.2%; and 84.0% and 62.5%. Conclusion From this large unique memory clinic cohort we suggest decade-specific MTA cut-off scores for clinical use. After age 85 years, however, the practical usefulness of the MTA cut-off is limited. Key Points • We suggest decade-specific MTA cut-off scores for AD. • MTA cut-off after the age of 85 years has limited use. • CT is feasible and accurate for visual MTA rating.
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Affiliation(s)
- Jules J Claus
- Department of Neurology, Tergooi Hospital, Blaricum, The Netherlands
| | - Salka S Staekenborg
- Department of Neurology, Tergooi Hospital, Blaricum, The Netherlands.,Department of Neurology, Alzheimer Center, VU University Medical Center, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Dana C Holl
- Department of Neurology, Tergooi Hospital, Blaricum, The Netherlands
| | - Jelmen J Roorda
- Department of Neurology, Tergooi Hospital, Blaricum, The Netherlands
| | - Jacqueline Schuur
- Department of Geriatrics, Tergooi Hospital, Blaricum, The Netherlands
| | - Pieter Koster
- Department of Radiology, Tergooi Hospital, Blaricum, The Netherlands
| | | | - Philip Scheltens
- Department of Neurology, Alzheimer Center, VU University Medical Center, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
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12
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Claus JJ, Staekenborg SS, Roorda JJ, Stevens M, Herderschee D, van Maarschalkerweerd W, Schuurmans L, Tielkes CE, Koster P, Bavinck C, Scheltens P. Low Prevalence of Mixed Dementia in a Cohort of 2,000 Elderly Patients in a Memory Clinic Setting. J Alzheimers Dis 2016; 50:797-806. [DOI: 10.3233/jad-150796] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Jules J. Claus
- Department of Neurology, Tergooi Hospitals, Blaricum, The Netherlands
| | - Salka S. Staekenborg
- Department of Neurology, Tergooi Hospitals, Blaricum, The Netherlands
- Alzheimer Center, Department of Neurology, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Jelmen J. Roorda
- Department of Neurology, Tergooi Hospitals, Blaricum, The Netherlands
| | - Martijn Stevens
- Department of Neurology, Tergooi Hospitals, Blaricum, The Netherlands
| | - Dirk Herderschee
- Department of Neurology, Tergooi Hospitals, Blaricum, The Netherlands
| | | | - Lilly Schuurmans
- Department of Geriatrics, Tergooi Hospitals, Blaricum, The Netherlands
| | | | - Pieter Koster
- Department of Radiology, Tergooi Hospitals, Blaricum, The Netherlands
| | | | - Philip Scheltens
- Alzheimer Center, Department of Neurology, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
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Claus JJ, Ongerboer De Visser BW, Bour LJ, Walstra GJ, Hijdra A, Verbeeten B, Van Royen EA, Kwa VI, van Gool WA. Determinants of quantitative spectral electroencephalography in early Alzheimer's disease: cognitive function, regional cerebral blood flow, and computed tomography. Dement Geriatr Cogn Disord 2000; 11:81-9. [PMID: 10705165 DOI: 10.1159/000017219] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Electroencephalography (EEG) bands may have different clinical or physiological correlates at initial diagnosis of Alzheimer's disease (AD). We studied 163 consecutive patients with probable (n = 105) and possible (n = 58) AD with measurements of cognitive function (CAMCOG), regional cerebral blood flow (rCBF) with single photon emission computed tomography using technetium-99m-labeled hexamethylpropylene amine oxime, and computed tomography (CT). Lower CAMCOG scores were significantly and most strongly associated with lower parieto-occipital and fronto-central alpha power. In a separate analysis of cognitive domains, disturbances in language, praxis, attention, and abstraction were also significantly and most consistently related to decrease in alpha power. Presence of cortical atrophy as measured on CT showed some statistically significant relations with EEG bands, but these associations were not consistent. Lower temporal and parietal rCBF were significantly related to lower parieto-occipital alpha activity. Presence of leukoaraiosis was significantly associated with lower beta values, but also with higher absolute theta and delta activity. The results suggest that alpha on EEG is most closely linked to cognitive function and rCBF, while beta and theta activity more likely reflect lower cortical or subcortical changes. Our study thus provides evidence that the EEG bands reflect differential pathophysiologic changes in AD.
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Affiliation(s)
- J J Claus
- Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands
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14
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Claus JJ, Strijers RL, Jonkman EJ, Ongerboer de Visser BW, Jonker C, Walstra GJ, Scheltens P, van Gool WA. The diagnostic value of electroencephalography in mild senile Alzheimer's disease. Clin Neurophysiol 1999; 110:825-32. [PMID: 10400195 DOI: 10.1016/s1388-2457(98)00076-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We investigated the diagnostic value of the visually assessed electroencephalogram (EEG) in patients with mild Alzheimer's disease (AD), using the grand total of EEG (GTE) score. METHODS Forty-nine non-demented control subjects with and without minimal cognitive impairment from the general population and 86 probable AD patients (NINCDS-ADRDA criteria), consecutively referred to a memory clinic, participated in this study. RESULTS Frequency of rhythmic background activity (P<0.05), diffuse slow activity (P<0.001), and reactivity of the rhythmic background activity (P<0.001) were statistically significant related to the diagnosis control subject or AD patient, using logistic regression analysis with adjustment for age and sex. When these subscores were used to confirm the diagnosis of AD, thus at high specificity of 89.1% (GTE cut-off point of 3), the sensitivity was 44.6% and positive predictive value was 88.1%. Incremental ruling-in and ruling-out curves showed a maximum diagnostic gain of 38% for a positive test result at a prior probability ranging from 30 to 40%. At high pretest probability levels of 80-90%, the diagnostic gain for a positive test result was low, varying from 7 to 14%. CONCLUSION In conclusion, the visually assessed EEG may give a clinically meaningful contribution to the diagnostic evaluation of AD when there is diagnostic doubt.
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Affiliation(s)
- J J Claus
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands.
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15
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Claus JJ, Walstra GJ, Hijdra A, Van Royen EA, Verbeeten B, van Gool WA. Measurement of temporal regional cerebral perfusion with single-photon emission tomography predicts rate of decline in language function and survival in early Alzheimer's disease. Eur J Nucl Med 1999; 26:265-71. [PMID: 10079318 DOI: 10.1007/s002590050387] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We determined the relationship between regional cerebral blood flow (rCBF) measured with single-photon emission tomography (SPET) and decline in cognitive function and survival in Alzheimer's disease. In a prospective follow-up study, 69 consecutively referred patients with early probable Alzheimer's disease (NINCDS/ADRDA criteria) underwent SPET performed at the time of initial diagnosis using technetium-99m-labelled hexamethylpropylene amine oxime. Neuropsychological function was assessed at baseline and after 6 months and survival data were available on all patients, extending to 5.5 years of follow-up. Lower left temporal (P<0.01) and lower left parietal (P<0.01) rCBF were statistically significantly related to decline in language function after 6 months. The association between left temporal rCBF and survival was also statistically significant (P<0.05) using Cox proportional hazards regression analysis. Performing analysis with quartiles of the distribution, we found a threshold effect for low left temporal rCBF (rCBF<73.7%, P<0. 01) and high risk of mortality. In this lowest quartile, median survival time was 2.7 years (follow-up to 5.2 years), compared with 4.4 years in the other quartiles (follow-up to 5.5 years). Kaplan-Meier survival curves showed statistically significant (P<0. 05, log rank test) survival curves for the lowest versus other quartiles of left temporal rCBF. All results were unaffected by adjustment for age, sex, dementia severity, duration of symptoms, education and ratings of local cortical atrophy. We conclude that left temporal rCBF predicts decline in language function and survival in patients with early probable Alzheimer's disease, with a threshold effect of low rCBF and high risk of mortality.
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Affiliation(s)
- J J Claus
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
BACKGROUND We studied whether heterogeneous profiles of cognitive function are relevant to survival in patients with early Alzheimer's disease. METHODS CAMCOG subscales of cognitive function were used as predictors of survival, together with gender in 157 consecutively referred patients with early Alzheimer's disease. Statistical analysis was performed with Cox proportional hazards analysis and Kaplan-Meier survival curves. Survival rates were compared with those in the general population. RESULTS Eighty patients (51%) died during the follow-up that extended to 5.7 years, with a median survival of 4.4 years after entry. Only the praxis subscore was statistically significant related to survival (P < 0.0001). Its predictive power was based on only two items, including copying ability for a spiral and a three-dimensional house, independent of age, sex, education, overall CAMCOG score, dementia severity and symptom duration. Kaplan-Meier curves for the combined score of these items (0, 1, or 2) showed three groups with significantly different survival rates for both men and women. Comparison of gender specific survival rates with data from the general population showed that excess mortality was statistically significant (P < 0.01) higher in men (51%) than in women (21%) after follow-up extending to 5 years. CONCLUSIONS A simple test of copying ability defines subgroups of AD patients with large differences in survival rates. This suggests that parietal lobe impairment is an important predictor of mortality in AD. Also, the course of AD may be more benign in women than in men.
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Affiliation(s)
- J J Claus
- Department of Neurology, Academic Medical Centre, University of Amsterdam, The Netherlands
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Claus JJ, Bour LJ, Ongerboer de Visser BW. Electroencephalography and survival in patients with Alzheimer's disease. Neurology 1998; 51:918-9. [PMID: 9748068 DOI: 10.1212/wnl.51.3.918-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Claus JJ, Kwa VI, Teunisse S, Walstra GJ, van Gool WA, Koelman JH, Bour LJ, Ongerboer de Visser BW. Slowing on quantitative spectral EEG is a marker for rate of subsequent cognitive and functional decline in early Alzheimer disease. Alzheimer Dis Assoc Disord 1998; 12:167-74. [PMID: 9772019 DOI: 10.1097/00002093-199809000-00008] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The relation between quantitative spectral electroencephalogram (qEEG) parameters and subsequent rate of cognitive, functional, and behavioral decline in 82 consecutive patients with early probable Alzheimer disease (NINCDS-ADRDA criteria) was examined in a prospective study. The qEEG was performed at initial examination and global cognitive function, activities of daily living, and behavior were assessed at initial evaluation and after a period of 6 months. Using multiple linear regression analysis, higher frontocentral and parieto-occipital theta values, lower parieto-occipital beta values, and lower peak frequency were significantly associated with more decline in global cognitive function over the follow-up period. In addition, lower parieto-occipital beta values were significantly related to more decline in activities of daily living. These associations were independent of demographic (age, sex, and education) and disease characteristics [initial Cambridge Examination for Mental Disorders of the Elderly Cognitive test (CAMCOG) or Mini-Mental State Examination scores, estimated duration of symptoms, estimated prior rate of decline, and dementia severity]. In a separate multiple logistic regression analysis, prediction of rapidly progressive decline, defined as 8 or more points decline in CAMCOG scores (n = 21), could be made with parieto-occipital and frontocentral beta values. The results suggest that slowing on qEEG is a marker for subsequent rate of cognitive and functional decline in mildly demented AD patients, independent of demographic or disease characteristics.
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Affiliation(s)
- J J Claus
- Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands.
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Claus JJ, van Gool WA, Teunisse S, Walstra GJ, Kwa VI, Hijdra A, Verbeeten B, Koelman JH, Bour LJ, Ongerboer De Visser BW. Predicting survival in patients with early Alzheimer's disease. Dement Geriatr Cogn Disord 1998; 9:284-93. [PMID: 9701680 DOI: 10.1159/000017073] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We investigated whether an index based on clinical features, electroencephalogram and computed tomography is useful to predict survival in early Alzheimer's disease. One hundred and sixty-three consecutively referred patients to an outpatient memory clinic and first diagnosed with Alzheimer's disease (105 'probable' and 58 'possible', NINCDS-ADRDA criteria) were studied and outcome measure was death. Cox proportional hazards regression analysis and Kaplan-Meier survival curves were used to investigate relations between baseline parameters and survival. Eighty-four patients (51. 5%) died during the follow-up period that extended to 5.8 years, with a median duration of survival after entry of 4.3 years. Baseline factors that were statistically significant and independently related to increased risk of mortality were high age, male sex, poor cognitive function as measured with the CAMCOG, low alpha and beta power on electroencephalogram, and temporoparietal atrophy on computed tomography scan. These results were independent of the diagnosis probable or possible Alzheimer's disease. Based on the coefficients from the regression equation, we computed a survival index for each patient and we constructed three groups according to tertiles of this index. After 5.2 years of follow-up, survival curves showed a low mortality group with 81.7% patients alive (median survival at least 5.7 years), an intermediate mortality group with 35.9% patients alive (median survival 3.8 years), and a high mortality group with no patients alive (median survival 2.3 years). Log rank tests were statistically significant for comparisons between all three groups. We conclude that an overall index combining demographic, cognitive, electroencephalogram and computed tomography features is a strong predictor of survival in early Alzheimer's disease.
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Affiliation(s)
- J J Claus
- Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands
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Claus JJ, Ongerboer de Visser BW, Walstra GJ, Hijdra A, Verbeeten B, van Gool WA. Quantitative spectral electroencephalography in predicting survival in patients with early Alzheimer disease. Arch Neurol 1998; 55:1105-11. [PMID: 9708961 DOI: 10.1001/archneur.55.8.1105] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine whether measures of quantitative spectral electroencephalography (EEG) can predict survival in patients with early Alzheimer disease. DESIGN Prospective cohort study; median duration of follow-up was 4.4 years in survivors and 2.6 years in nonsurvivors. Cox proportional hazards models, with adjustment for age and sex were used to estimate relationships between EEG measures and survival. Log relative percentage values of EEG bands were used as predictors. SETTING Outpatient university memory clinic. PARTICIPANTS One hundred one consecutively referred patients with early probable Alzheimer disease according to National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria were studied with EEG at the time of diagnosis. The mean age of the patients was 79.2 years, which was higher than in previous EEG studies. MAIN OUTCOME MEASURE Mortality. RESULTS Fifty-one patients (50.5%) died during follow-up, with a median survival time in all patients of 4.1 years. The following EEG variables were significantly associated with increased risk of mortality: from parieto-occipital leads, higher theta (hazard ratio, 2.05; 95% confidence interval, 1.15-3.66; P<.05), lower alpha (hazard ratio, 0.43; 95% confidence interval, 0.25-0.76; P<.01), and lower beta (hazard ratio, 0.38; 95% confidence interval, 0.22-0.68; P<.001) activity; and from frontocentral leads, higher theta activity (hazard ratio, 2.07; 95% confidence interval, 1.17-3.66; P<.05). Stepwise Cox regression analysis showed that loss of parieto-occipital beta (P<.01) and alpha (P<.05) power were independent and significant predictors of mortality. Both beta (12.6-35.4 Hz) and alpha (7.5-12.5 Hz) activity remained significantly associated with mortality after adjustment for education, dementia severity, symptom duration, level of cognitive function, presence of extrapyramidal symptoms or hallucinations, presence of vascular risk factors, and presence of leukoaraiosis or local cortical atrophy. CONCLUSIONS Decreases of beta and alpha activity on quantitative spectral EEG are independent predictors of mortality in patients with early Alzheimer disease. In the clinical context, the use of EEG technology for prediction of survival in individual patients remains to be determined.
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Affiliation(s)
- J J Claus
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
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Claus JJ, Teunisse S, Walstra GJ, van Gool WA. Determinants of global clinical change assessment in patients with early Alzheimer's disease. Dement Geriatr Cogn Disord 1998; 9:157-63. [PMID: 9622004 DOI: 10.1159/000017041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Global clinical impression (GCI) of change is assumed to integrate aspects of both cognitive and noncognitive functioning. We evaluated 140 consecutive patients with probable (n = 90) and possible (n = 50) early Alzheimer's disease at baseline and after 6 months with measurements of global cognitive function (CAMCOG), behavior, activities of daily living, and burden of the caregiver. After 6 months, both the clinician (GCI-clin) and the caregiver (GCI-care) rated clinical change on a 3-point scale (worse, no change, improved). Data were analyzed with multiple polychotomous logistic regression, adjusted for age and sex. Change in global cognitive function and GCI-care were significantly and independently related to GCI-clin, while changes in activities of daily living and in behavior were significantly and independently associated with GCI-care. The findings suggest a double dissociation. Change in cognition appears to be the major determinant of the clinician's global impression but not change in behavioral and functional parameters, while global impression of the caregiver is primarily based on change in behavioral and functional measures but not on change in cognition.
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Affiliation(s)
- J J Claus
- Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands
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de Munck JC, Verster FC, Dubois EA, Habraken JB, Boltjes B, Claus JJ, van Herk M. Registration of MR and SPECT without using external fiducial markers. Phys Med Biol 1998; 43:1255-69. [PMID: 9623654 DOI: 10.1088/0031-9155/43/5/015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of our work is to present, test and validate an automated registration method used for matching brain SPECT scans with corresponding MR scans. The method was applied on a data set consisting of ten brain IDEX SPECT scans and ten T1- and T2-weighted MR scans of the same subjects. Of two subjects a CT scan was also made. (Semi-) automated algorithms were used to extract the brain from the MR, CT and SPECT images. Next, a surface registration technique called chamfer matching was used to match the segmented brains. A perturbation study was performed to determine the sensitivity of the matching results to the choice of the starting values. Furthermore, the SPECT segmentation threshold was varied to study its effect on the resulting parameters and a comparison between the use of MR T1- and T2-weighted images was made. Finally, the two sets of CT scans were used to estimate the accuracy by matching MR to CT and comparing the MR-SPECT match to the SPECT-CT match. The perturbation study showed that for initial perturbations up to 6 cm the algorithm fails in less than 4% of the cases. A variation of the SPECT segmentation threshold over a realistic range (25%) caused an average variation in the optimal match of 0.28 cm vector length. When T2 is used instead of T1 the stability of the algorithm is comparable but the results are less realistic due the large deformations. Finally, a comparison of the direct SPECT-MR match and the indirect match with CT as intermediate yields a discrepancy of 0.4 cm vector length. We conclude that the accuracy of our automatic matching algorithm for SPECT and MR, in which no external markers were used, is comparable to the accuracies reported in the literature for non-automatic methods or methods based on external markers. The proposed method is efficient and insensitive to small variations in SPECT segmentation.
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Affiliation(s)
- J C de Munck
- The Netherlands Cancer Institute (Antoni van Leeuwenhoek Huis), Radiotherapy Department, Amsterdam.
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Claus JJ, de Koning I, van Harskamp F, Breteler MM, Voet B, Gutzmann H, Dahlke F, van der Cammen T, Hofman A. Lisuride treatment of Alzheimer's disease. A preliminary placebo-controlled clinical trial of safety and therapeutic efficacy. Clin Neuropharmacol 1998; 21:190-5. [PMID: 9617511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In this article, the authors examine the effect of lisuride on 22 patients with probable Alzheimer's disease (NINCDS/ADRDA criteria) in a randomized double-blind, placebo-controlled, parallel group design. Ten patients received lisuride and 12 patients received placebo. Lisuride was administered in a dose-finding phase of four weeks and an efficacy phase of eight weeks, with a maximum dose of 0.3 mg daily. Outcome measures included global clinical impression, general cognitive function, mood, verbal and visual memory, attention, and psychomotor function. Average decline in Mini-Mental State Examination score after 12 weeks treatment was less often statistically significant in lisuride treated patients than in patients receiving a placebo (p < 0.05). Patients treated with lisuride improved their average total score and short-delay cued recall score on the California Verbal Learning Test, a test of verbal memory, whereas placebo-treated patients showed worse performance compared with baseline. These differences approached statistical significance, with p = 0.06 and p = 0.05, respectively. No other differences between the treatment groups were evident. The authors failed to find a consistent effect of lisuride on symptoms of Alzheimer's disease. However, this study's sample size was relatively small, and larger studies are needed to ascertain the treatment effects of serotonergic antagonists on Alzheimer's disease.
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Affiliation(s)
- J J Claus
- Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands
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Abstract
A 30-year-old AIDS-patient with cryptococcal meningitis developed subacute bilateral visual loss associated with high cerebrospinal fluid (CSF) pressure. With immediate CSF drainage the blindness was reversible. The importance of prompt CSF drainage in AIDS-related cryptococcal meningitis with visual failure is stressed.
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Affiliation(s)
- J J Claus
- Department of Neurology, Academic Medical Centre, University of Amsterdam, The Netherlands
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Claus JJ, Breteler MM, Hasan D, Krenning EP, Bots ML, Grobbee DE, Van Swieten JC, Van Harskamp F, Hofman A. Regional cerebral blood flow and cerebrovascular risk factors in the elderly population. Neurobiol Aging 1998; 19:57-64. [PMID: 9562504 DOI: 10.1016/s0197-4580(98)00004-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Regional cerebral blood flow (rCBF) was studied in 60 elderly persons (aged 65 to 84 years) recruited from a population-based study, with single photon emission computed tomography using technetium 99m-labeled hexamethylpropylene amine oxime. We investigated whether it is only age that affects rCBF or whether other factors can be indentified that explain this relationship. Using multiple linear regression analysis, increasing age was significantly associated with rCBF decrease in parietal, temporo-parietal, and temporal cortex, but not in frontal cortex. Adjustment with several risk factors for cerebrovascular disease, including hypertension, history of myocardial infarction, factor VIIc, factor VIIIc, cholesterol and HDL cholesterol, smoking, and diabetes mellitus had no influence on these relations. Conversely, the association between age and rCBF was no longer statistically significant after adjustment with fibrinogen and indicators of carotid atherosclerosis, including intima-media wall thickness of the carotid artery and plaques in the carotid artery. Correction with local ratings of cortical atrophy did not affect the relations between age and rCBF. The results suggest that in the elderly population rCBF declines with age in posterior cortical areas and that these changes may well be explained by the presence of atherosclerosis. Reduced contractility of the vascular muscle wall with increasing age resulting from atherosclerosis may be the underlying mechanism.
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Affiliation(s)
- J J Claus
- Department of Epidemiology & Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands.
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Claus JJ, Dubois EA, Booij J, Habraken J, de Munck JC, van Herk M, Verbeeten B, van Royen EA. Demonstration of a reduction in muscarinic receptor binding in early Alzheimer's disease using iodine-123 dexetimide single-photon emission tomography. Eur J Nucl Med 1997; 24:602-8. [PMID: 9169565 DOI: 10.1007/bf00841396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Decreased muscarinic receptor binding has been suggested in single-photon emission tomography (SPET) studies of Alzheimer's disease. However, it remains unclear whether these changes are present in mildly demented patients, and the role of cortical atrophy in receptor binding assessment has not been investigated. We studied muscarinic receptor binding normalized to neostriatum with SPET using [123I]4-iododexetimide in five mildly affected patients with probable Alzheimer's disease and in five age-matched control subjects. Region of interest (ROI) analysis was performed in a consensus procedure blind to clinical diagnosis using matched magnetic resonance (MRI) images. Cortical atrophy was assessed by calculating percentages of cerebrospinal fluid in each ROI. An observer study with three observers was conducted to validate this method. Alzheimer patients showed statistically significantly less [123I]4-iododexetimide binding in left temporal and right temporo-parietal cortex compared with controls, independent of age, sex and cortical atrophy. Mean intra-observer variability was 3.6% and inter-observer results showed consistent differences in [123I]4-iododexetimide binding between observers. However, differences between patients and controls were comparable among observers and statistically significant in the same regions as in the consensus procedure. Using an MRI-SPET matching technique, we conclude that [123I]4-iododexetimide binding is reduced in patients with mild probable Alzheimer's disease in areas of temporal and temporo-parietal cortex.
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Affiliation(s)
- J J Claus
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
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Abstract
Visuospatial deficits in basal ganglia disease may be a non-specific function of the severity of dementia or they could reflect disease-specific impairments. To examine this question, Huntington (HD) patients, demented and non-demented Parkinson (PD) patients and healthy controls were examined with neuropsychological tests emphasising visuospatial abilities. Global intellectual function and general visuospatial cognition were less efficient in the two demented patient groups relative to both controls and non-demented PD patients and they did not differ significantly between non-demented Parkinsonians and controls nor between demented PD and HD patients. However, HD patients but not demented PD patients were impaired on a test of person-centred spatial judgement compared to non-demented subjects while demented PD patients scored significantly lower than HD patients on a test of field independence. Factor analysis yielded a factor reflecting general visuospatial processing capacity which discriminated between demented and non-demented PD patients but not between demented PD and HD patients. A unique factor associated with the manipulation of person-centred space discriminated between demented PD and HD patients. These results suggest general visuospatial processing is impaired as a non-specific function of dementia presence in HD and PD. Abnormalities in circumscribed aspects of visuospatial function, on the other hand, may differentiate between HD and PD, suggesting differential involvement of the basal ganglia in the respective illnesses.
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Affiliation(s)
- E Mohr
- Division of Neurology, University of Ottawa, Ottawa Civic Hospital & Elisabeth Bruyere Health Centre, Ottawa, Canada
| | - J J Claus
- Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - P Brouwers
- HIV and AIDS Malignancy, Division of Clinical Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Claus JJ. Clinicopathological studies of Alzheimer disease. Arch Neurol 1996; 53:837. [PMID: 8815846 DOI: 10.1001/archneur.1996.00550090019004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Claus JJ, Breteler MM, Hasan D, Krenning EP, Bots ML, Grobbee DE, van Swieten JC, van Harskamp F, Hofman A. Vascular risk factors, atherosclerosis, cerebral white matter lesions and cerebral perfusion in a population-based study. Eur J Nucl Med 1996; 23:675-82. [PMID: 8662102 DOI: 10.1007/bf00834530] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We studied risk factors for cerebral vascular disease (blood pressure and hypertension, factor VIIc, factor VIIIc, fibrinogen), indicators of atherosclerosis (intima-media thickness and plaques in the carotid artery) and cerebral white matter lesions in relation to regional cerebral blood flow (rCBF) in 60 persons (aged 65-85 years) recruited from a population-based study. rCBF was assessed with single-photon emission tomography using technetium-99m d, l-hexamethylpropylene amine oxime (99mTc-HMPAO). Statistical analysis was performed with multiple linear regression with adjustment for age, sex and ventricle-to-brain ratio. A significant positive association was found between systolic and diastolic blood pressure and temporo-parietal rCBF. In analysis with quartiles of the distribution, we found a threshold effect for the relation of low diastolic blood pressure (</=60 mmHg) and low temporo-parietal rCBF. Levels of plasma fibrinogen were inversely related to parietal rCBF, with a threshold effect of high fibrinogen levels (>3.2 g/l) and low rCBF. Increased atherosclerosis was related to low rCBF in all cortical regions, but these associations were not significant. No consistent relation was observed between severity of cerebral white matter lesions and rCBF. Our results may have implications for blood pressure control in the elderly population.
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Affiliation(s)
- J J Claus
- Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands
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Abstract
INTRODUCTION Attentional deficits have been shown in Alzheimer's disease but it is unknown whether this reflects disease specific impairment or is present in other neurodegenerative disorders. MATERIALS & METHODS We administered a verbal dichotic listening task (free recall and selective allocation to the left or right ear) to 17 patients with Alzheimer's disease, 19 patients with Huntington's disease, 10 patients with idiopathic Parkinson's disease with clinical evidence of dementia (DemPD), 22 non-demented patients with Parkinson's disease (PD), and 22 healthy controls. Patients with dementia were matched for dementia severity and performance in the 3 recall conditions was used as a measure of attentional capacity. RESULTS Patients with dementia (Alzheimer and Huntington patients, DemPD) were less accurate than those without dementia (PD and normal subjects). Demented subjects performed at comparable levels regardless of specific diagnosis; likewise those without dementia also achieved similar levels. All groups had a right ear preference under the free recall condition. Alzheimer and Huntington patients showed consistent right ear preference under all recall conditions, while PD patients, like controls, could selectively allocate attention to the left under left ear recall, regardless of the presence of dementia. CONCLUSION The findings suggest a double dissociation. Non-selective attentional processing is affected by dementia presence versus absence but not by specific disease, while selective attentional processing shows disease specific impairments, regardless of the presence of dementia.
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Affiliation(s)
- J J Claus
- Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands
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Brouwers P, Mohr E, Hildebrand K, Hendricks M, Claus JJ, Baron IS, Young M, Pierce P. A novel approach to the determination and characterization of HIV dementia. Neurol Sci 1996; 23:104-9. [PMID: 8738921 DOI: 10.1017/s0317167100038804] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Neuropsychological studies of the pattern and extent of cognitive impairment in HIV-infected patients have mostly used deviations from control values and/or cut-off scores as criteria for classification of dementia. There is, however, no agreement as to how to define impairment, and classification is imprecise. METHOD The current study used a dementia classification matrix, developed with a step-wise linear discriminant analysis of neuropsychological data from patients with primary neurodegenerative dementias, to classify symptomatic HIV patients as demented or non-demented, and further to differentiate cortical and subcortical dementia patterns. Thirty-two male and 2 female patients (mean age 39 +/- 2) with symptomatic HIV disease (mean absolute CD4 count 195 +/- 41) participated in the study. RESULTS Thirty-five per cent of patients were classified as demented. Of these, 83% showed a subcortical pattern and 17% a cortical profile of deficits. Significant differences between patients classified as subcortically demented and those categorized as normal on neuropsychological measures associated with subcortical integrity further validated the classification. Measures of psychiatric status between subgroups were similar. CONCLUSION Since certain treatments may delay or reverse cognitive deficits, the use of an objective classification method based on discriminant analysis may help to identify patients who may benefit from therapy.
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Affiliation(s)
- P Brouwers
- Pediatric Branch, National Cancer Institute, NIH, Bethesda, Maryland 20892, USA
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Claus JJ, Kuijper EJ, de Gans J. [Listeria meningitis in adults]. Ned Tijdschr Geneeskd 1996; 140:113-6. [PMID: 8618625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- J J Claus
- Afd. Neurologie, Academisch Medisch Centrum, Amsterdam
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Ott A, Breteler MM, van Harskamp F, Claus JJ, van der Cammen TJ, Grobbee DE, Hofman A. Prevalence of Alzheimer's disease and vascular dementia: association with education. The Rotterdam study. BMJ 1995; 310:970-3. [PMID: 7728032 PMCID: PMC2549358 DOI: 10.1136/bmj.310.6985.970] [Citation(s) in RCA: 424] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To estimate the prevalence of dementia and its subtypes in the general population and examine the relation of the disease to education. DESIGN Population based cross sectional study. SETTING Ommoord, a suburb of Rotterdam. SUBJECTS 7528 participants of the Rotterdam study aged 55-106 years. RESULTS 474 cases of dementia were detected, giving an overall prevalence of 6.3%. Prevalence ranged from 0.4% (5/1181 subjects) at age 55-59 years to 43.2% (19/44) at 95 years and over. Alzheimer's disease was the main subdiagnosis (339 cases; 72%); it was also the main cause of the pronounced increase in dementia with age. The relative proportion of vascular dementia (76 cases; 16%), Parkinson's disease dementia (30; 6%), and other dementias (24; 5%) decreased with age. A substantially higher prevalence of dementia was found in subjects with a low level of education. The association with education was not due to confounding by cardiovascular disease. CONCLUSIONS The prevalence of dementia increases exponentially with age. About one third of the population aged 85 and over has dementia. Three quarters of all dementia is due to Alzheimer's disease. In this study an inverse dose-response relation was found between education and dementia--in particular, Alzheimer's disease.
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Affiliation(s)
- A Ott
- Erasmus University Medical School, Rotterdam, Netherlands
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Mohr E, Brouwers P, Claus JJ, Purdon SE, Gagnon M, Chase TN. Differential classification of dementia. Behav Neurol 1995; 8:23-30. [PMID: 24487399 DOI: 10.3233/ben-1995-8103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
In the absence of biological markers, dementia classification remains complex both in terms of characterization as well as early detection of the presence or absence of dementing symptoms, particularly in diseases with possible secondary dementia. An empirical, statistical approach using neuropsychological measures was therefore developed to distinguish demented from non-demented patients and to identify differential patterns of cognitive dysfunction in neurodegenerative disease. Age-scaled neurobehavioral test results (Wechsler Adult Intelligence Scale-Revised and Wechsler Memory Scale) from Alzheimer's (AD) and Huntington's (HD) patients, matched for intellectual disability, as well as normal controls were used to derive a classification formula. Stepwise discriminant analysis accurately (99% correct) distinguished controls from demented patients, and separated the two patient groups (79% correct). Variables discriminating between HD and AD patient groups consisted of complex psychomotor tasks, visuospatial function, attention and memory. The reliability of the classification formula was demonstrated with a new, independent sample of AD and HD patients which yielded virtually identical results (classification accuracy for dementia: 96%; AD versus HD: 78%). To validate the formula, the discriminant function was applied to Parkinson's (PD) patients, 38% of whom were classified as demented. The validity of the classification was demonstrated by significant PD subgroup differences on measures of dementia not included in the discriminant function. Moreover, a majority of demented PD patients (65%) were classified as having an HD-like pattern of cognitive deficits, in line with previous reports of the subcortical nature of PD dementia. This approach may thus be useful in classifying presence or absence of dementia and in discriminating between dementia subtypes in cases of secondary or coincidental dementia.
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Affiliation(s)
- E Mohr
- SCO Hospitals, Elisabeth Bruyere Health Center, Rm 298-20, 75 Bruyere St, Ottawa, Ontario, Canada K1N 5C8
| | - P Brouwers
- SCO Hospitals, Elisabeth Bruyere Health Center, Rm 298-20, 75 Bruyere St, Ottawa, Ontario, Canada K1N 5C8
| | - J J Claus
- SCO Hospitals, Elisabeth Bruyere Health Center, Rm 298-20, 75 Bruyere St, Ottawa, Ontario, Canada K1N 5C8
| | - S E Purdon
- SCO Hospitals, Elisabeth Bruyere Health Center, Rm 298-20, 75 Bruyere St, Ottawa, Ontario, Canada K1N 5C8
| | - M Gagnon
- SCO Hospitals, Elisabeth Bruyere Health Center, Rm 298-20, 75 Bruyere St, Ottawa, Ontario, Canada K1N 5C8
| | - T N Chase
- SCO Hospitals, Elisabeth Bruyere Health Center, Rm 298-20, 75 Bruyere St, Ottawa, Ontario, Canada K1N 5C8
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Claus JJ, van Harskamp F, Breteler MM, Krenning EP, van der Cammen TJ, Hofman A, Hasan D. Assessment of cerebral perfusion with single-photon emission tomography in normal subjects and in patients with Alzheimer's disease: effects of region of interest selection. Eur J Nucl Med 1994; 21:1044-51. [PMID: 7828613 DOI: 10.1007/bf00181058] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The shape, size and location of regions of interest (ROIs) show considerable variability between single-photon emission tomography (SPET) studies in aging and Alzheimer's disease, but the possible influence on study results remains unknown. We compared three different ROIs in a SPET study with 60 controls and in 48 patients with probable Alzheimer's disease diagnosed according to the NINCDS-ADRDA criteria. Regional cerebral blood flow (rCBF) was assessed with SPET using technetium-99m d,l-hexamethylpropylene amine oxime (99mTc-HMPAO), normalized to the mean activity in a cerebellar reference slice. The three different ROIs were: a multi-slice and a single-slice ROI with reference to the normal brain anatomy (using an anatomical atlas), and a rectangular (2 x 4 pixels) ROI in the frontal, temporal, temporoparietal and occipital cortices. No differences were observed for the means of rCBF values between the single-slice and multi-slice ROI's with reference to the normal anatomy, but some variability was present for individual comparisons. In contrast, significantly higher mean rCBF values were obtained with the single-slice rectangular ROIs in all four regions for both patients and controls and considerable variability was shown for individual subjects. After analysis with multivariate logistic regression and receiver operator characteristic curves, the ability of SPET to discriminate between controls and Alzheimer patients was similar in the three methods for mild and moderate Alzheimer patients (Global Deterioration Scale = GDS of 3 and 4). However, with increasing dementia severity (GDS > 4) the rectangular ROIs showed lower ability to discriminate between groups compared to the single-slice and multi-slice anatomically defined ROIs.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J J Claus
- Department of Neurology, University Hospital Rotterdam Dijkzigt, The Netherlands
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Breteler MM, van Swieten JC, Bots ML, Grobbee DE, Claus JJ, van den Hout JH, van Harskamp F, Tanghe HL, de Jong PT, van Gijn J. Cerebral white matter lesions, vascular risk factors, and cognitive function in a population-based study: the Rotterdam Study. Neurology 1994; 44:1246-52. [PMID: 8035924 DOI: 10.1212/wnl.44.7.1246] [Citation(s) in RCA: 671] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Cerebral white matter lesions are a common finding on MRI in elderly persons. We studied the prevalence of white matter lesions and their relation with classic cardiovascular risk factors, thrombogenic factors, and cognitive function in an age- and gender-stratified random sample from the general population that consisted of 111 subjects 65 to 84 years of age. Overall, 27% of subjects had white matter lesions. The prevalence and severity of lesions increased with age. A history of stroke or myocardial infarction, factor VIIc activity, and fibrinogen level were each significantly and independently associated with the presence of white matter lesions. Significant relations with blood pressure level, hypertension, and plasma cholesterol were present only for subjects aged 65 to 74 years. White matter lesions tended to be associated with lower scores on tests of cognitive function and were significantly associated with subjective mental decline. This study suggests that classic cardiovascular risk factors, as well as thrombogenic factors, are associated with white matter lesions in subjects over 65 years of age in the general population, and that these lesions may be related to cognitive function.
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Affiliation(s)
- M M Breteler
- Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands
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Breteler MM, Claus JJ, Grobbee DE, Hofman A. Cardiovascular disease and distribution of cognitive function in elderly people: the Rotterdam Study. BMJ 1994; 308:1604-8. [PMID: 8025427 PMCID: PMC2540432 DOI: 10.1136/bmj.308.6944.1604] [Citation(s) in RCA: 341] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the distribution of cognitive function in elderly people and to assess the impact of clinical manifestations of atherosclerotic disease on this distribution. DESIGN Single centre population based cross sectional door to door study. SETTING Ommoord, a suburb of Rotterdam, the Netherlands. SUBJECTS 4971 subjects aged 55 to 94 years. MAIN OUTCOME MEASURE Cognitive function as measured by the mini mental state examination. RESULTS The overall participation rate in the study was 80%. Cognitive test data were available for 90% of the participants. Increasing age and lower educational level were associated with poorer cognitive function. Previous vascular events, presence of plaques in the carotid arteries, and presence of peripheral arterial atherosclerotic disease were associated with worse cognitive performance independent of the effects of age and education. On average the differences were moderate; however, they reflected the net result of a shift of the total population distribution of cognitive function towards lower values. Thereby, they resulted in a considerable increase in the proportion of subjects with scores indicative of dementia. CONCLUSIONS These findings are compatible with the view that atherosclerotic disease accounts for considerable cognitive impairment in the general population.
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Affiliation(s)
- M M Breteler
- Department of Epidemiology, Erasmus University Medical School, Rotterdam, Netherlands
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Breteler MM, van Amerongen NM, van Swieten JC, Claus JJ, Grobbee DE, van Gijn J, Hofman A, van Harskamp F. Cognitive correlates of ventricular enlargement and cerebral white matter lesions on magnetic resonance imaging. The Rotterdam Study. Stroke 1994; 25:1109-15. [PMID: 8202966 DOI: 10.1161/01.str.25.6.1109] [Citation(s) in RCA: 204] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE Ventricular enlargement and white matter lesions are frequent findings on cerebral magnetic resonance imaging scans of elderly subjects. In demented subjects they seem related to the severity of the dementia, but in nondemented subjects their clinical significance is less clear. We investigated the relation of size of the lateral ventricles and white matter lesions with cognitive function in a population-based random sample of nondemented elderly persons. METHODS The study population consisted of 90 subjects, aged 65 to 84 years, who were randomly selected from the cohort of the Rotterdam Study, and who were not demented. The presence of white matter lesions and the ventricle-to-brain ratio were assessed on magnetic resonance scans. Participants were tested with a neuropsychological battery that covered a broad range of cognitive functions. RESULTS Ventricular enlargement and white matter lesions were both and independently associated with poorer performance on all tests. After adjustment for age and sex, ventricular enlargement was significantly associated with worse scores on tests assessing global cognitive function (Mini-Mental State Examination, P = .02; Groninger Intelligence Test, P = .01), memory (Word List Learning delayed recall, P = .03), and executive control functions (Stroop part II, P = .02; Trial Making Test B, P < .01); for white matter lesions the differences were significant for tests measuring executive control functions and mental speed (Trail Making Test A and B, P = .01 and P < .01, respectively; verbal fluency, P = .01), and memory (Word List Learning delayed recall, P = .04). CONCLUSIONS This study suggests that white matter lesions are primarily related to impairment of subcorticofrontal functions, whereas enlargement of the lateral ventricles is associated with disturbances of cortical functions as well.
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Affiliation(s)
- M M Breteler
- Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands
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Claus JJ, van Harskamp F, Breteler MM, Krenning EP, de Koning I, van der Cammen TJ, Hofman A, Hasan D. The diagnostic value of SPECT with Tc 99m HMPAO in Alzheimer's disease: a population-based study. Neurology 1994; 44:454-61. [PMID: 8145915 DOI: 10.1212/wnl.44.3_part_1.454] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We studied the diagnostic accuracy of single-photon emission computed tomography (SPECT) with technetium 99m-labeled hexamethylpropylene amine oxime (Tc 99m HMPAO) in 48 patients with probable Alzheimer's disease (AD) according to NINCDS-ADRDA criteria and in 60 controls recruited from a population-based study. With logistic regression, we identified decreased temporal regional cerebral blood flow as the best discriminating variable between patients and controls. Receiver-operator characteristic curves showed that the discriminative ability of SPECT improved with increasing dementia severity. With specificity set at 90%, sensitivity figures were 42% in mild, 56% in moderate, and 79% in severe AD. The diagnostic gain as a function of the prior probability of the disease being present was computed for those with mild AD. When the prior probability varied at around 50%, the diagnostic gain for mild AD patients was substantial (a maximum of 34%) for a positive test result but poor for a negative test result. The results suggest that the practical usefulness of SPECT as a diagnostic adjunct in patients suspected of having mild AD is confined to situations in which, on clinical grounds, there is considerable diagnostic doubt.
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Affiliation(s)
- J J Claus
- Department of Neurology, University Hospital Rotterdam, Dijkzigt, The Netherlands
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Claus JJ, Hofman A, Jolles J. [Pharmacological therapy of Alzheimer's disease]. Ned Tijdschr Geneeskd 1992; 136:2463-6. [PMID: 1465168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J J Claus
- Erasmus Universiteit, afd. Epidemiologie en Biostatistiek, Rotterdam
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Affiliation(s)
- M M Breteler
- Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands
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Abstract
The cognitive-enhancing effects of pramiracetam in animal models of learning and memory are characterized by an inverted U-shaped dose-response curve. We evaluated antidementia efficacy of this drug in 10 patients with probable Alzheimer's disease employing a 2-phase, placebo-controlled, enrichment-type trial design. Eight patients evidenced a best dose in the dose-finding phase, but in the subsequent replication phase only two again improved to a similar degree. PETs with fluorodeoxyglucose obtained in two individuals showed no definite change. Doses up to 4,000 mg pramiracetam are unlikely to confer symptomatic benefit to Alzheimer's disease patients.
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Affiliation(s)
- J J Claus
- Experimental Therapeutics Branch, National Institutes of Neurological Disorders and Stroke, Bethesda, MD 20892
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Claus JJ, Mohr E, Chase TN. Clinical trials in dementia: learning effects with repeated testing. J Psychiatry Neurosci 1991; 16:1-4. [PMID: 2049365 PMCID: PMC1188280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The possible confounding role of learning effects during multiple test administration in clinical trials in demented subjects remains uncertain. Seventeen mildly to severely affected patients with Alzheimer's disease (AD) and 16 controls were evaluated with an extensive neuropsychological battery of manually administered and computerized tests. Subjects received 3 weekly sessions using alternate test forms, to mimic a baseline, placebo, and drug condition. Mean scores of AD patients as a group showed no stable improvement, but more subtle learning effects were suggested by an association of dementia severity and change scores in verbal and visual learning. Controls evidenced consistent learning in 3 of 9 tests. These results suggest that clinical trials data from AD patients, especially those with moderately severe impairment, are not contaminated by learning. Degree of cognitive impairment may be related to learning capacity, suggesting caution for learning effects in controls and possibly in patients with mild AD.
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Affiliation(s)
- J J Claus
- Experimental Therapeutics Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD 20892
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Abstract
The notion of specificity of visuospatial dysfunction in Huntington's disease (HD) was evaluated in a sample of afflicted patients as a function of symptom duration, age at onset, and overall dementia severity. Factor analytic procedures indicated that overall visuospatial processing capacity (factor 1) as well as the ability for spatial manipulation (factor 3) was markedly affected in HD patients. In contrast, consistency of spatial judgment (factor 2) appeared to remain relatively intact in these patients. Age at onset seemed to have no relationship with any of these variables, whereas dementia severity demonstrated a significant relationship with overall visuospatial processing capacity. Most importantly, duration of symptoms was significantly associated with the declining ability to mentally perform spatial manipulations. The observation of circumscribed visuospatial impairment in HD patients may have important consequences for the further understanding of the neurobehavioral consequences of this disorder.
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Affiliation(s)
- E Mohr
- Medical Neurology Branch, NINDS, National Institutes of Health, Bethesda, Maryland
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Abstract
A loss of cortical noradrenergic innervation may contribute to the intellectual deterioration in Alzheimer's disease. To test the hypothesis that noradrenergic replacement may confer symptomatic benefit, a double-blind, placebo-controlled therapeutic trial with clonidine hydrochloride (Catapres), a centrally active noradrenergic receptor agonist, was undertaken in eight patients with the clinical diagnosis of Alzheimer's disease. No statistically significant changes in cognitive function were found over a range of doses, including those that produced clinically observable side effects. These preliminary results indicate a need for alternative noradrenergic replacement strategies in Alzheimer's disease.
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Affiliation(s)
- E Mohr
- Medical Neurology Branch, National Institute of Neurological and Communicative Disorders and Stroke, Bethesda, MD 20892
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