Alzheimer's Disease Today & Tomorrow

Archives of Neurology, 2001

Background: Mild cognitive impairment (MCI) is considered to be a transitional stage between aging and Alzheimer disease (AD). Objective: To determine whether MCI represents earlystage AD by examining its natural history and neuropathologic basis. Design: A prospective clinical and psychometric study of community-living elderly volunteers, both nondemented and minimally cognitively impaired, followed up for up to 9.5 years. Neuropathologic examinations were performed on participants who had undergone autopsy. Setting: An AD research center. Participants: All participants enrolled between July 1990 and June 1997 with Clinical Dementia Rating (CDR) scores of 0 (cognitively healthy; n = 177; mean age, 78.9 years) or 0.5 (equivalent to MCI; n=277; mean age, 76.9 years). Based on the degree of clinical confidence that MCI represented dementia of the Alzheimer type (DAT), 3 subgroups of individuals with CDR scores of 0.5 were identified: CDR 0.5/DAT, CDR 0.5/incipient DAT, and CDR 0.5/uncertain dementia. Main Outcome Measure: Progression to the stage of CDR 1, which characterizes mild definite DAT. Results: Survival analysis showed that 100% of CDR 0.5/ DAT participants progressed to greater dementia severity over a 9.5-year period. At 5 years, rates of progression to a score of CDR 1 (or greater) for DAT were 60.5% (95% confidence interval [CI], 50.2%-70.8%) for the CDR 0.5/DAT group, 35.7% (95% CI, 21.0%-50.3%) for the CDR 0.5/incipient DAT group, 19.9% (95% CI, 8.0%-31.8%) for the CDR 0.5/uncertain dementia group, and 6.8% (95% CI, 2.2%-11.3%) for CDR 0/controls. Progression to greater dementia severity correlated with degree of cognitive impairment at baseline. Twenty-four of the 25 participants with scores of CDR 0.5 had a neuropathologic dementing disorder, which was AD in 21 (84%). Conclusions: Individuals currently characterized as having MCI progress steadily to greater stages of dementia severity at rates dependent on the level of cognitive impairment at entry and they almost always have the neuropathologic features of AD. We conclude that MCI generally represents early-stage AD.

Journal of The American Academy of Nurse Practitioners, 1997

Guideline No. 79, which was developed by a multidisciplinary panel composed of health care professionals and consumer representatives. The Quick Reference Guide focuses on (a) symptoms that suggest the presence of a dementing disorder and (b) steps to follow in conducting an initial assessment for Alzheimer's disease or a related dementia, including use of specific mental and functional status tests on the basis of their efficacy and clinical utility in discriminating early-stage dementia. It also addresses how to interpret test results, the role of neuropsychological testing, and resources for patients and families facing a diagnosis of probable dementia. PURPOSE AND SCOPE Dementia is a syndrome of progressive decline that relentlessly erodes intellectual abilities, causing cognitive and functional deterioration leading to impairment of social and occupational functioning. Because Alzheimer's disease is the most common dementing illness in the United States, it is used as a prototype for dementia in this guide unless otherwise stated.

Current Psychology, 2023

In this study, we investigated the ability of commonly used neuropsychological tests to detect cognitive and functional decline across the Alzheimer's disease (AD) continuum. Moreover, as preclinical AD is a key area of investigation, we focused on the ability of neuropsychological tests to distinguish the early stages of the disease, such as individuals with Subjective Memory Complaints (SMC). This study included 595 participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset who were cognitively normal (CN), SMC, mild cognitive impairment (MCI; early or late stage), or AD. Our cognitive measures included the Rey Auditory Verbal Learning Test (RAVLT), the Everyday Cognition Questionnaire (ECog), the Functional Abilities Questionnaire (FAQ), the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), the Montreal Cognitive Assessment scale (MoCA), and the Trail Making test (TMT-B). Overall, our results indicated that the ADAS-13, RAVLT (learning), FAQ, ECog, and MoCA were all predictive of the AD progression continuum. However, TMT-B and the RAVLT (immediate and forgetting) were not significant predictors of the AD continuum. Indeed, contrary to our expectations ECog self-report (partner and patient) were the two strongest predictors in the model to detect the progression from CN to AD. Accordingly, we suggest using the ECog (both versions), RAVLT (learning), ADAS-13, and the MoCA to screen all stages of the AD continuum. In conclusion, we infer that these tests could help clinicians effectively detect the early stages of the disease (e.g., SMC) and distinguish the different stages of AD.

Alzheimer's & Dementia, 2011

With regard to potential conflicts of interest, Marilyn Albert serves as a consultant to Genentech and Eli Lilly and receives grants to her institution from GE Healthcare. Steven DeKosky serves as a consultant to Eisai, Merck, Elan/Wyeth, Novartis, he serves on the advisory board of Pfizer and provides clinical services to United Healthcare. Dennis Dickson report no conflicts. Bruno Dubois serves as a consultant to Affiris, Pierre Fabre, and Eisai, serving on a scientific advisory board for Bristol-Meyers Squibb, Roche, Pfizer, Eli Lilly, and GE Healthcare, and receives grants to his institution from Novartis, Roche, and Eisai. Howard Feldman is an employee of Bristol Meyers Squibb (BMS) and holds stock in BMS; he serves as a consultant to Servier, Glia Scientific, and Pfizer, and serves on a scientific advisory board for Elan, Janssen, Canada, and Wyeth. Nick Fox serves as a consultant (payment to Institute of Neurology) for BMS, Elan/Janssen, Eli Lilly, GE, Lundbeck, and Pfizer/Wyeth. The Institute of Neurology (Nick Fox) has conducted image analysis for Elan/Janssen, Lundbeck, and Pfizer/Wyeth. Anthony Gamst reports no conflicts. David Holtzman serves as a consultant for Bristol-Myers Squibb, Pfizer, and Innogenetics; he serves on a scientific advisory board for En Vivo, Satori, and C2N Diagnostics; and receives grants to his institution from Pfizer, Eli Lilly, and Astra Zeneca. William Jagust serves as a consultant to Genentech, Bayer Healthcare, GE Healthcare. Synarc, Otsuka Pharmaceuticals, Janssen Alzheimer Immunotherapy, Merck, and Tau Rx. Ronald Petersen serves as a consultant for Elan Pharmaceuticals and GE Healthcare and serves on data monitoring committees for Pfizer, Inc., Janssen Alzheimer Immunotherapy. Peter Snyder serves as a consultant to CogState Ltd. Maria Carrillo is an employee of the Alzheimer's Association and reports no conflicts. Bill Thies is an employee of the Alzheimer's Association and reports no conflicts.

International Psychogeriatrics, 2011

The recently published revised National Institute on Aging/Alzheimer's Association clinical diagnostic criteria for Alzheimer's disease (AD) (Albert et al., 2011; Jack et al., 2011; McKhann et al., 2011; Sperling et al., 2011) have been hailed for incorporating a number of timely and important advances. They reflect new understanding that has been gained since the previous criteria were published in 1984 (McKhann et al., 1984). They include recognition of the state of mild cognitive impairment that is present before the threshold is crossed into dementia; they recognize the potential role of biomarkers in enhancing the specificity of diagnosis; they also address emerging work in the preclinical stage of AD that could help in understanding the sequence and stages of the core pathology before symptoms emerge. Among the previously listed diagnostic features that have disappeared was the requirement that onset of dementia occur before the age of 90 years. Meanwhile, the Neurocog...