This research investigated two groups of patients diagnosed with dementia before the age of sixty-five. The patients were diagnosed with Alzheimer’s Disease (AD, n = 25) and Frontotemporal Dementia (FTD, n = 37). Patients were assessed for approximately 3 years. The study found that FTD is a valid and useful diagnostic category, and can be reliably differentiated from AD. A combination of behavioural, neurological, and neuropsychological assessments were found to be complementary in the early and accurate diagnosis of early-onset dementia, and the differential diagnosis of FTD from AD. FTD patients were found to have relatively preserved visuo-spatial abilities compared to the AD patients. Problems associated with administering neuropsychological tests to early-onset dementia patients were highlighted. FTD patients were found to deteriorate more rapidly than AD patients, and to have significantly increased behavioural disturbances throughout the course of the illness in comparison with the AD patients. Practical guidelines to assist with care and management of early-onset dementia patients were presented. A strengths-based model of care was outlined. Individualised assessments and care plans were recommended for the development and provision of humane services to early-onset dementia patients. Issues surrounding providing palliative care were discussed.

No description available.

INTRODUÇÃO: Apesar de existir uma ampla variedade de testes para detecção de demências, muitos deles possuem limitações para a aplicação na prática clínica, principalmente em cenários de atenção primária à saúde. Com o intuito de se obter um questionário de rápida aplicação, adequado à realidade de nossa população e que tenha uma acurácia adequada foi criado o questionário de mudança cognitiva (QMC). O QMC foi desenvolvido por profissionais da área cognitiva através da seleção de questões com foco na detecção de estágios inicias das demências. OBJETIVOS: Avaliar se a aplicação do Questionário de Mudança Cognitiva (QMC) pode distinguir com boa acurácia indivíduos normais daqueles com Comprometimento Cognitivo Leve (CCL) e/ou demências em estágios iniciais, comparando-o com testes cognitivos utilizados na prática clínica, e desenvolver, a partir do questionário inicial com 22 questões, um final com 8 questões que mostre boa acurácia na identificação de indivíduos com demências em estágios iniciais, para que seja utilizado na prática clínica como um instrumento de rastreio cognitivo. MÉTODOS: Trabalho prospectivo, realizado de abril de 2007 a setembro de 2010, onde foram avaliados indivíduos encaminhados de forma aleatória e sem diagnóstico prévio ao Centro de Referência em Distúrbios Cognitivos (CEREDIC/HCFMUSP). No total, 123 indivíduos foram examinados, sendo 42 controles, 40 com CCL e 41 com demências leves (CDR=1). A avaliação foi realizada através de testes baseados em desempenho do indivíduo como o Mini Exame do Estado Mental, o CAMCOG e a bateria breve de rastreio cognitivo, além de testes aplicados ao informante como o questionário de atividades funcionais de Pfeffer(QFAP), o inventário neuropsiquiátrico, o IQ-CODE, o Clinical Dementia Rating (CDR) e o QMC. O QMC foi formado a partir da seleção de 22 questões que especialistas com experiência na área cognitiva achavam serem úteis para o rastreio de demência em estágios precoces. O diagnóstico final, utilizado como padrão-ouro nas análises estatísticas e comparações, foi realizado por consenso de uma banca formada por clínicos atuantes na área cognitiva e com critérios baseados no DSM-IV e NINCDS/ADRDA. RESULTADOS: O QMC com 22 questões mostrou ter boa acurácia no diagnóstico entre indivíduos normais daqueles com alterações cognitivas ou demências leves. A partir deste questionário, foram selecionadas, através de modelos estatísticos, as oito questões com maior poder de discriminação entre os grupos avaliados (controles, CCL e Demências). As curvas ROC relacionadas à versão final do QMC com oito questões mostraram valores que variaram de ROC=0,892 (comparação entre CCL e demências) até ROC=0,999 (comparação entre controles com demências), demonstrando boa acurácia na diferenciação entre os grupos. O QMC8 foi o teste com a melhor acurácia dentre todos os realizados, ao se avaliar os valores da área sob a curva (ROC) para a diferenciação entre indivíduos Controles daqueles com alterações cognitivas associadas ao CCL ou às demências. A correlação de Spearman do QMC8 com o diagnóstico final foi de r=0,861, menor apenas em relação ao CDR. O QMC8 mostrou ter boa correlação os testes aplicados no presente estudo e que já são validados para o diagnóstico de demências, além de apresentar uma adequada consistência interna, com alfa de Cronbach de 0,876. CONCLUSÃO: Tanto o QMC22, quanto o QMC8 são testes de boa acurácia para a diferenciação entre indivíduos normais daqueles com CCL e demências em estágios iniciais. O QMC8 apresentou boa correlação com testes já utilizados e validados em nosso meio e adequada consistência interna. Assim, como é um questionário breve, com apenas 8 itens, parece adequado para uso como instrumento de rastreio cognitivo em nosso meio / BACKGROUND: Although there are a wide variety of tests to detect dementia, many of them have limitations for application in clinical practice, especially in settings of primary health care. In order to achieve rapid implementation of a questionnaire, adapted to the reality of our population and has an adequate accuracy was created the questionnaire of cognitive change (QMC). The QMC was developed by professionals through the cognitive selection of questions focused on detecting early stages of dementia. OBJECTIVES: To evaluate whether implementation of the Questionnaire of Cognitive Change (QMC) can distinguish with good accuracy normal subjects from those with mild cognitive impairment (MCI) and / or dementia in the early stages, compared with the cognitive tests used in clinical practice, and develop from the initial questionnaire with 22 questions, a final with 8 questions that show good accuracy in identifying individuals with dementia in the early stages, to be used in clinical practice as a tools for cognitive screening. METHODS: Prospective study conducted from April 2007 to September 2010 were evaluated individuals randomically referred and without a previous diagnosis to the Reference Center for Cognitive Disorders (CEREDIC / FMUSP). In total, 123 individuals were examined, 42 controls, 40 with MCI and 41 with mild dementia (CDR = 1). The evaluation was performed using tests based on individual performance as the Mini Mental State Examination, the CAMCOG and brief cognitive screening battery, and testing as applied to the informant questionnaire on functional activities of Pfeffer (QFAP), the Neuropsychiatric Inventory, IQCODE, the Clinical Dementia Rating (CDR) and QMC. The QMC was formed from the selection of 22 questions that experts with experience in cognitive evaluation thought to be useful for screening of dementia in early stages. The final diagnosis used as the gold standard in the statistical analysis and comparisons, was performed by consensus of a panel formed by clinicians working in the cognitive settings and criteria based on DSM-IV and NINCDS / ADRDA. RESULTS: The QMC with 22 questions showed have good diagnostic accuracy in normal subjects from those with mild cognitive impairment and / or dementia. From this questionnaire, were selected through statistical models, the eight questions with the highest discrimination power among the groups (controls, MCI and dementia). The ROC curves related to the final version of the QMC with eight questions showed values ranging from ROC = 0.892 (comparison between MCI and dementia) to ROC = 0.999 (comparing controls with dementia), showing good accuracy in differentiating between groups. The QMC8 was the test with the best accuracy among all done, we evaluated the values of area under the curve (ROC) to differentiate between controls individuals those with cognitive impairment associated with dementia or MCI. The Spearman correlation of QMC8 with the final diagnosis was r = 0.861. The QMC8 showed a good correlation between the tests used in this study and that are already validated for the diagnosis of dementia, and present an adequate internal consistency with Cronbach\'s alpha of 0.876. CONCLUSIONS: Both QMC22 and QMC8 were tests with good accuracy for differentiating between normal subjects from those with mild cognitive impairment and dementia in early stages. The QMC8 showed good correlation with tests already used and validated in our environment and adequate internal consistency. As it is a brief questionnaire, with only 8 items, it seems appropriate to use as a tool for cognitive screening in our midst

Previous studies suggested that the Functional Activities Questionnaire (FAQ-10) has minimal ethnic bias and that a shorter version (FAQ-6) can equally diagnose MCI and dementia. Objective: We analyzed whether FAQ-6 is similar to FAQ-10 in diagnosing MCI and dementia. We examined their applicability across European Americans (EA) and Hispanic Americans, and how scores correlated to beta amyloid. Method: 222 participants (116 EA) completed a neuropsychological battery, FAQ, and PET scans, and were classified as cognitively normal (CN), MCI, or dementia. The diagnostic capacity of FAQ-10 and FAQ-6 were compared for the total sample and across ethnic groups. Scores were correlated to beta amyloid. Results: Both versions showed good item discrimination. Ethnicity did not affect scores when controlling for diagnosis and education. Both versions classified CN and dementia, and positively correlated to beta amyloid. Conclusions: Results suggest FAQ-6 and FAQ-10 similarly predict diagnosis and is adequate in these ethnic groups. / Includes bibliography. / Thesis (M.A.)--Florida Atlantic University, 2018. / FAU Electronic Theses and Dissertations Collection

The purpose of this study was to investigate the construct validity of the eight subscales of the Cambridge Cognitive Examination (CAMCOG). A confirmatory factor analysis was conducted to determine if the subscales of the CAMCOG, as proposed by its authors (Roth et al., 1986), were able to adequately describe the total set of relations among the set of individual scale items.The subjects consisted of 224 male and female individuals obtained through a study to examine the validity of the CAMCOG on a United States population. The subjects were divided into two separate groups: those diagnosed as having a dementing illness and a normal comparison group. The CAMCOG was administered to each subject as a measure of neuropsychological functioning by a trained professional or paraprofessional.Two models were established a priori for the confirmatory factor analysis. The first model was based on the theory of Roth et al. (1986) which suggested there are eight factors within the CAMCOG. The second model was developed as a one-factor solution and was based on the present author's theory that the CAMCOG is a general measure of brain impairment and that all data would be best explained by one common factor. Maximum likelihood estimates were calculated using LISREL VII (Joreskog & Sorbom, 1989).The results of the study suggest that the eight-factor model of the CAMCOG proposed by its authors (Roth et al., 1986) provided a significantly better explanation of the data than did the one factor model proposed by the author of this study. However, neither one of the models postulated was found to adequately describe the covariance of the obtained data. Accordingly, the validity of the constructs of the CAMCOG as proposed by Roth et al. (1986) is considered to be questionable. Suggestions for further research are presented. / Department of Counseling Psychology and Guidance Services

INTRODUÇÃO: Apesar de existir uma ampla variedade de testes para detecção de demências, muitos deles possuem limitações para a aplicação na prática clínica, principalmente em cenários de atenção primária à saúde. Com o intuito de se obter um questionário de rápida aplicação, adequado à realidade de nossa população e que tenha uma acurácia adequada foi criado o questionário de mudança cognitiva (QMC). O QMC foi desenvolvido por profissionais da área cognitiva através da seleção de questões com foco na detecção de estágios inicias das demências. OBJETIVOS: Avaliar se a aplicação do Questionário de Mudança Cognitiva (QMC) pode distinguir com boa acurácia indivíduos normais daqueles com Comprometimento Cognitivo Leve (CCL) e/ou demências em estágios iniciais, comparando-o com testes cognitivos utilizados na prática clínica, e desenvolver, a partir do questionário inicial com 22 questões, um final com 8 questões que mostre boa acurácia na identificação de indivíduos com demências em estágios iniciais, para que seja utilizado na prática clínica como um instrumento de rastreio cognitivo. MÉTODOS: Trabalho prospectivo, realizado de abril de 2007 a setembro de 2010, onde foram avaliados indivíduos encaminhados de forma aleatória e sem diagnóstico prévio ao Centro de Referência em Distúrbios Cognitivos (CEREDIC/HCFMUSP). No total, 123 indivíduos foram examinados, sendo 42 controles, 40 com CCL e 41 com demências leves (CDR=1). A avaliação foi realizada através de testes baseados em desempenho do indivíduo como o Mini Exame do Estado Mental, o CAMCOG e a bateria breve de rastreio cognitivo, além de testes aplicados ao informante como o questionário de atividades funcionais de Pfeffer(QFAP), o inventário neuropsiquiátrico, o IQ-CODE, o Clinical Dementia Rating (CDR) e o QMC. O QMC foi formado a partir da seleção de 22 questões que especialistas com experiência na área cognitiva achavam serem úteis para o rastreio de demência em estágios precoces. O diagnóstico final, utilizado como padrão-ouro nas análises estatísticas e comparações, foi realizado por consenso de uma banca formada por clínicos atuantes na área cognitiva e com critérios baseados no DSM-IV e NINCDS/ADRDA. RESULTADOS: O QMC com 22 questões mostrou ter boa acurácia no diagnóstico entre indivíduos normais daqueles com alterações cognitivas ou demências leves. A partir deste questionário, foram selecionadas, através de modelos estatísticos, as oito questões com maior poder de discriminação entre os grupos avaliados (controles, CCL e Demências). As curvas ROC relacionadas à versão final do QMC com oito questões mostraram valores que variaram de ROC=0,892 (comparação entre CCL e demências) até ROC=0,999 (comparação entre controles com demências), demonstrando boa acurácia na diferenciação entre os grupos. O QMC8 foi o teste com a melhor acurácia dentre todos os realizados, ao se avaliar os valores da área sob a curva (ROC) para a diferenciação entre indivíduos Controles daqueles com alterações cognitivas associadas ao CCL ou às demências. A correlação de Spearman do QMC8 com o diagnóstico final foi de r=0,861, menor apenas em relação ao CDR. O QMC8 mostrou ter boa correlação os testes aplicados no presente estudo e que já são validados para o diagnóstico de demências, além de apresentar uma adequada consistência interna, com alfa de Cronbach de 0,876. CONCLUSÃO: Tanto o QMC22, quanto o QMC8 são testes de boa acurácia para a diferenciação entre indivíduos normais daqueles com CCL e demências em estágios iniciais. O QMC8 apresentou boa correlação com testes já utilizados e validados em nosso meio e adequada consistência interna. Assim, como é um questionário breve, com apenas 8 itens, parece adequado para uso como instrumento de rastreio cognitivo em nosso meio / BACKGROUND: Although there are a wide variety of tests to detect dementia, many of them have limitations for application in clinical practice, especially in settings of primary health care. In order to achieve rapid implementation of a questionnaire, adapted to the reality of our population and has an adequate accuracy was created the questionnaire of cognitive change (QMC). The QMC was developed by professionals through the cognitive selection of questions focused on detecting early stages of dementia. OBJECTIVES: To evaluate whether implementation of the Questionnaire of Cognitive Change (QMC) can distinguish with good accuracy normal subjects from those with mild cognitive impairment (MCI) and / or dementia in the early stages, compared with the cognitive tests used in clinical practice, and develop from the initial questionnaire with 22 questions, a final with 8 questions that show good accuracy in identifying individuals with dementia in the early stages, to be used in clinical practice as a tools for cognitive screening. METHODS: Prospective study conducted from April 2007 to September 2010 were evaluated individuals randomically referred and without a previous diagnosis to the Reference Center for Cognitive Disorders (CEREDIC / FMUSP). In total, 123 individuals were examined, 42 controls, 40 with MCI and 41 with mild dementia (CDR = 1). The evaluation was performed using tests based on individual performance as the Mini Mental State Examination, the CAMCOG and brief cognitive screening battery, and testing as applied to the informant questionnaire on functional activities of Pfeffer (QFAP), the Neuropsychiatric Inventory, IQCODE, the Clinical Dementia Rating (CDR) and QMC. The QMC was formed from the selection of 22 questions that experts with experience in cognitive evaluation thought to be useful for screening of dementia in early stages. The final diagnosis used as the gold standard in the statistical analysis and comparisons, was performed by consensus of a panel formed by clinicians working in the cognitive settings and criteria based on DSM-IV and NINCDS / ADRDA. RESULTS: The QMC with 22 questions showed have good diagnostic accuracy in normal subjects from those with mild cognitive impairment and / or dementia. From this questionnaire, were selected through statistical models, the eight questions with the highest discrimination power among the groups (controls, MCI and dementia). The ROC curves related to the final version of the QMC with eight questions showed values ranging from ROC = 0.892 (comparison between MCI and dementia) to ROC = 0.999 (comparing controls with dementia), showing good accuracy in differentiating between groups. The QMC8 was the test with the best accuracy among all done, we evaluated the values of area under the curve (ROC) to differentiate between controls individuals those with cognitive impairment associated with dementia or MCI. The Spearman correlation of QMC8 with the final diagnosis was r = 0.861. The QMC8 showed a good correlation between the tests used in this study and that are already validated for the diagnosis of dementia, and present an adequate internal consistency with Cronbach\'s alpha of 0.876. CONCLUSIONS: Both QMC22 and QMC8 were tests with good accuracy for differentiating between normal subjects from those with mild cognitive impairment and dementia in early stages. The QMC8 showed good correlation with tests already used and validated in our environment and adequate internal consistency. As it is a brief questionnaire, with only 8 items, it seems appropriate to use as a tool for cognitive screening in our midst

This study examined differences in scoring patterns among those diagnosed with Alzheimer's dementia and vascular dementia on the clock-drawing test. Archival clock drawing data was retrieved on 279 patients presenting at a county hospital-based memory clinic. Analysis of drawings was based on frequency of qualitative errors, as well as an overall quantitative score. Mean comparisons found those patients with Alzheimer's dementia to perform worse on both quantitative and qualitative scoring measures. However, Pearson's chi-squared test revealed a significantly higher rate of spacing errors among subjects with vascular dementia. Such lends support to my hypothesis that impaired executive functioning in vascular dementia patients would lead to poor qualitative performance. Logistic regression found significant predictive ability for the qualitative criteria in diagnosis (χ2 = 25.49, p < .001), particularly the rate of omission (z = 8.96, p = .003) and addition errors (z = 7.58, p = .006). Such findings hold important implications for the use of qualitative criteria in cognitive screening assessments.

The present series of investigations examined the diagnostic accuracy of the Cognitive Examination (CAMCOG) from the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) in the differential diagnosis of various dementing conditions. Specifically, this study examined: (a) the degree to which the CAMCOG would differentiate normal individuals from patients with Alzheimer's Disease (AD) and from those suffering from non-AD dementing conditions, (b) the extent to which the CAMCOG would distinguish between patients suffering from organic dementing conditions, those having functional psychiatric disorders, and normal persons, and (c) whether the CAMCOG would offer an improvement in diagnostic accuracy over a widely used screening instrument (i.e., the Mini-Mental Status Examination, MMSE) when attempting to differentially diagnose dementing patients and normal cohorts.A review of the literature was presented with an emphasis on the difficulties in establishing differential diagnosis, inaccuracies in diagnosis, the importance of improved diagnostic accuracy, and the use of neuropsychological measures in the assessment and diagnosis of patients suffering from dementing illnesses. Further, research relevant to ancillary diagnostic techniques, the various neuropsychologicalapproaches used in evaluating and diagnosing mental disorders in the elderly, and studies investigating the utility of specific cognitive/neuropsychological measures in the differential diagnosis of dementing diseases was presented.The results of these investigations revealed that the CAMCOG provides excellent diagnostic sensitivity and specificity when differentiating normal persons from clinically diagnosed AD patients and when distinguishing between individuals with an organic-dementing condition and normal adults. The CAMCOG was found to be less effective in differentiating AD and non-AD dementia patients and in distinguishing between patients suffering from organic dementia versus specified psychiatric disorders. Finally, the CAMCOG demonstrated a slight improvement in diagnostic accuracy over the Mini-Mental Status Examination. These results were discussed in terms of their support for the utility of the CAMCOG as an excellent screening measure when used to differentiate patients suffering from various dementia-producing disease states and normal persons. / Department of Educational Psychology

[Truncated abstract] Background: Dementia, largely due to Alzheimer's disease (AD), is a major public health problem. The early identification of disease is an important challenge for clinicians because treatment of AD is now available. A simple and accurate means of stratifying risk for AD and identifying early disease is needed so that risk factor modification and treatment can occur optimally. To date, despite many attempts, an accurate means of standardising an approach to the assessment of subtle cognitive symptoms has not been developed. A subjective complaint of poor memory has been identified as a possible marker for underlying brain disease. This study examines the utility of neuropsychological scores, homocysteine levels, APOE genotyping and brain imaging as predictors of cognitive decline in individuals with subjective memory complaint (SMC). Method Eighty subjects with SMC were recruited from memory clinics and the community (MC: 1). Forty-two control subjects were also examined (MC: 0). CAMDEX was used to describe baseline clinical features. The CAMCOG was used as a global test of cognition and was administered annually for four years. At baseline, neuropsychological testing was administered. Cranial CT scanning, measurement of plasma homocysteine and APOE genotyping were completed. Categorical variables were analysed using chi-square according to Pearson's method. Continuous data was analysed using Student's t-tests and Mann-Whitney tests. A logistic regression model was used to identify independent contributors to the presence of memory complaint. Participants were then matched for age, gender and time to follow-up (up for three years) to determine longitudinal predictors of cognitive decline. ... Baseline CAMCOG scores were greater in the control group (MC:0 = 98.3 ? 2.8, MC:1 94.2 ? 5.5, Z ?4.46, p 0.000). There were no differences in neuropsychological scores, concentration of total plasma homocysteine, APOE genotype or brain scan measurements. Using the Wald stepwise selection method, logistic regression could not be established due to non-convergence regardless of whether or not the continuous variables were re-coded into dichotomous variables. A matching process that created 32 pairs of controls/subjects allowed follow-up analysis. The controls showed significant improvement with time on the CAMCOG unlike subjects (mean ? SD, controls 1.5 ?-3.0, Z - 2.61, p 0.01, subjects 0.2 ? 3.2, Z ? 0.24, p 0.81). The logistic regression analysis showed that group membership could not be defined by any single independent variable. When group membership was abandoned and those with stable scores were compared to those who declined no clear meaningful independent predictors of decline apart from age were identified. Conclusions: Methodological issues such as small sample size and inadequate follow up duration were identified that may have precluded identification of predictive factors for cognitive decline. The results indicate that complaints of memory problems are not associated with established risk factors for Alzheimer's disease and fail to predict objective cognitive decline over three years. Future studies should continue trying to identify robust predictors of cognitive decline in later life.

M. Tech. / Memory loss refers to the loss of ability to learn new information and the inability to retrieve information previously learnt (Karlawish & Clark, 2003). It is estimated that more than 40% of individuals over the age of 60 are affected by memory loss (Jackson, 2004). There are no recommended treatment options available for mild forms of memory loss (D‟Esposito & Weksler, 2000). The aim of the study was to determine the effects of the anthroposophical medicine, Scleron® in the treatment of memory loss associated with ageing, assessed by digit span; verbal and visual recall and recognition and a memory questionnaire. The trial was a double-blind placebo controlled study using matched pairs. Participants selected to take part in the study were between the ages of 60 and 75 and presented with subjective symptoms of memory loss. Participants were excluded from the study if they scored less than 24 out of 30 on the Mini-Mental State Exam; were previously diagnosed with memory or cognitive disorders; had a previous history of stroke, epilepsy, head injury, psychiatric disease and drug or alcohol dependence. Participants were divided into two groups in matched pairs according to age, education level, occupation and Mini-Mental State Exam scores. At the start of the study, participants completed a memory test and memory questionnaire. Participants in the experimental group received Scleron®, while participants in the placebo group received unmedicated tablets. Participants were required to take 2 tablets in the morning for a period of six weeks. The memory test and memory questionnaire was once again completed by participants at the end of the study. Thirty six participants completed the study. The results of the study were analysed and frequencies and descriptives were calculated for the sample group. The Wilcoxon test was used to compare the data within groups, while the Mann-Whitney test was used to compare the results between the two groups. iv After analysis of the results of the study, it was concluded that Scleron® did not appear to improve the symptoms of memory loss when using tests of digit span, verbal and visual recall or verbal and visual recognition. Furthermore, it did not appear to improve subjective symptoms of memory loss assessed by the use of a memory questionnaire.