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Journal of Alzheimer’s Disease xx (20xx) x–xx DOI 10.3233/JAD-142724 IOS Press
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A Simple Tool to Reach Populations at Risk for Developing Dementia and Alzheimer’s Disease
or P
1
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Noa Bregmana,∗ , Keren Regeva , Orna Moorea , Nir Giladib,c and Elissa Asha
5
a Memory
6
b Sackler
uth
7
and Attention Disorders Center, Tel Aviv “Sourasky” Medical Center, Tel Aviv, Israel School of Medicine, Tel Aviv University, Tel Aviv, Israel c Department of Neurology, Tel Aviv “Sourasky” Medical Center, Tel Aviv, Israel
Accepted 7 February 2015
15
Keywords: Alzheimer’s disease, dementia, mild cognitive impairment, prevention, screening, subjective cognitive impairment
16
INTRODUCTION
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The early detection of people who are at risk for developing dementia and Alzheimer’s disease (AD) is one of the major challenges in the field of therapeutic development. Disease modifying medications are still not available for the treatment of AD, thus reaching an early diagnosis is a complicated ethical issue of much debate, Some believe that early diagnosis when symptoms are minimal before the appearance of significant cognitive decline may be beneficial to the patient and his family, while some believe that as long as therapy is not available, people should not be informed of a diagnosis. Expert consensus guidelines state that early detection of cognitive decline can optimize medical management, offer relief based on better understanding of symptoms, maximize decision making autonomy and planning for the future, and
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Abstract. Identification of individuals at high risk for developing dementia and Alzheimer’s disease is a major challenge. A “memory fair” is an enjoyable and affordable tool designed to reach local population at risk, mainly those with subjective cognitive impairment (SCI) or mild cognitive impairment. The fair included a free cognitive assessment and presentation on the importance of sleep, physical activity, cognitive training, and risk-factors and provided personalized recommendations. 160 individuals completed the evaluation (69.97 ± 9.01 y, 83% women). Average Montreal Cognitive Assessment Score (MoCA) was 24.73 ± 3.71. Six percent reported SCI and an upper estimate of mild cognitive impairment prevalence was 30.7%. SCI was found to be a sensitive predictor for MoCA 25 were referred to their primary care physician for ongoing follow up, and participants with scores of 25 or less were referred for further evaluation and follow-up care with a neurologist. Secondary prevention trials in AD are now being designed and will require documentation of brain amyloidosis for enrollment [27]. The identification of noninvasive, low-cost measures that would reduce the number of subjects needed to be screened using expensive amyloid PET scan or lumbar punctures for cerebrospinal fluid amyloid levels, would greatly improve the efficiency of clinical trials targeting the preclinical disease phase. A recent study that had examined indicators of Pittsburgh compound B (PiB)–PET imaging positivity, found that subjective memory complaints are as good predictors of PiB positivity as cognitive test performance, and that easily obtainable information such as age, sex, APOE genotype, family history of dementia, and subjective memory complaints, would greatly reduce costs of screening and the number of individuals needed to be screened using much more expensive assessments such as brain amyloidosis [28]. We suggest that conducting a “memory fair”, an easily accessible and enjoyable event for the local population, can serve as a simple, relatively low-cost tool to attract people at risk for developing dementia and AD.
[3]
[4]
[5]
[6]
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[8] [9]
[10] [11]
[12]
Prince M, Bryce R, Ferri C (2011) World Alzheimer Report 2011. The Benefits of Early Diagnosis and Intervention. Alzheimer’s Disease International, London. Holsinger T, Deveau J, Boustani M, Williams JW Jr (2007) Does this patient have dementia? JAMA 297, 2391-2404. Ganguli M, Rodriguez E, Mulsant B, Richards S, Pandav R, Bilt JV, Dodge HH, Stoehr GP, Saxton J, Morycz RK, Rubin RT, Farkas B, DeKosky ST (2004) Detection and management of cognitive impairment in primary care: The Steel Valley Seniors Survey. J Am Geriatr Soc 52, 1668-1675. Valcour VG, Masaki KH, Curb JD, Blanchette PL (2000) The detection of dementia in the primary care setting. Arch Intern Med 160, 2964-2968. Olafsdottir M, Skoog I, Marcusson J (2000) Detection of dementia in primary care: The Linkoping study. Dement Geriatr Cogn Disord 11, 223-229. Chodosh J, Petitti DB, Elliott M, Hays RD, Crooks VC, Reuben DB, Galen Buckwalter J, Wenger N (2004) Physician recognition of cognitive impairment: Evaluating the need for improvement. J Am Geriatr Soc 52, 1051-1059. Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, Gamst A, Holtzman DM, Jagust WJ, Petersen RC, Snyder PJ, Carrillo MC, Thies B, Phelps CH (2011) The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement 7, 270-279. Petersen RC (2004) Mild cognitive impairment as a diagnostic entity. J Intern Med 256, 183-194. Bennett DA, Wilson RS, Schneider JA, Evans DA, Beckett LA, Aggarwal NT, Barnes LL, Fox JH, Bach J (2002) Natural history of mild cognitive impairment in older persons. Neurology 59, 198-205. Iliffe S, Pealing L (2010) Subjective memory problems. BMJ 340, c1425. Jonker C, Geerlings MI, Schmand B (2000) Are memory complaints predictive for dementia? A review of clinical and population-based studies. Int J Geriatr Psychiatry 15, 983991. Amariglio RE, Townsend MK, Grodstein F, Sperling RA, Rentz DM (2011) Specific subjective memory complaints in older persons may indicate poor cognitive function. J Am Geriatr Soc 59, 1612-1617.
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Mini-Mental State Examination (MMSE) scores. J Clin Exp Neuropsychol 34, 750-757. Athilingam P, King KB, Burgin SW, Ackerman M, Cushman LA, Chen L (2011) Montreal Cognitive Assessment and MiniMental Status Examination compared as cognitive screening tools in heart failure. Heart Lung 40, 521-529. Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, Nordberg A, B¨ackman L, Albert M, Almkvist O, Arai H, Basun H, Blennow K, de Leon M, DeCarli C, Erkinjuntti T, Giacobini E, Graff C, Hardy J, Jack C, Jorm A, Ritchie K, van Duijn C, Visser P, Petersen RC (2004) Mild cognitive impairment–beyond controversies, towards a consensus: Report of the International Working Group on Mild Cognitive Impairment. J Intern Med 256, 240-246. Busse A, Hensel A, Guhne U, Angermeyer MC, Riedel-Heller SG (2006) Mild cognitive impairment: Long-term course of four clinical subtypes. Neurology 67, 2176-2185. Petersen RC, Roberts RO, Knopman DS, Geda YE, Cha RH, Pankratz VS, Boeve BF, Tangalos EG, Ivnik RJ, Rocca WA (2010) Prevalence of mild cognitive impairment is higher in men. The Mayo Clinic Study of Aging. Neurology 75, 889897. Visser PJ, Verhey F, Knol DL, Scheltens P, Wahlund LO, Freund-Levi Y, Tsolaki M, Minthon L, Wallin AK, Hampel H, B¨urger K, Pirttila T, Soininen H, Rikkert MO, Verbeek MM, Spiru L, Blennow K (2009) Prevalence and prognostic value of CSF markers of Alzheimer’s disease pathology in patients with subjective cognitive impairment or mild cognitive impairment in the DESCRIPA study: A prospective cohort study. Lancet Neurol 8, 619-627. Sperling RA, Jack CR Jr, Aisen PS (2011) Testing the right target and right drug at the right stage. Sci Transl Med 3, 111cm133. Mielke MM, Wiste HJ, Weigand SD, Knopman DS, Lowe VJ, Roberts RO, Geda YE, Swenson-Dravis DM, Boeve BF, Senjem ML, Vemuri P, Petersen RC, Jack CR Jr (2012) Indicators of amyloid burden in a population-based study of cognitively normal elderly. Neurology 79, 1570-1577. Barnes DE, Yaffe K (2011) The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurol 10, 819-828.
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[27]
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Cooper C, Bebbington P, Lindesay J, Meltzer H, McManus S, Jenkins R, Livingston G (2011) The meaning of reporting forgetfulness: A cross-sectional study of adults in the English 2007 Adult Psychiatric Morbidity Survey. Age Ageing 40, 711-717. Reid LM, Maclullich AM (2006) Subjective memory complaints and cognitive impairment in older people. Dement Geriatr Cogn Disord 22, 471-485. Palmer K, Backman L, Winblad B, Fratiglioni L (2003) Detection of Alzheimer’s disease and dementia in the preclinical phase: Population based cohort study. BM 326, 245. Mitchell AJ (2008) The clinical significance of subjective memory complaints in the diagnosis of mild cognitive impairment and dementia: A meta-analysis. Int J Geriatr Psychiatry 23, 1191-1202. Jessen F, Wiese B, Bachmann C, Eifflaender-Gorfer S, Haller F, K¨olsch H, Luck T, M¨osch E, van den Bussche H, Wagner M, Wollny A, Zimmermann T, Pentzek M, RiedelHeller SG, Romberg HP, Weyerer S, Kaduszkiewicz H, Maier W, Bickel H (2010) Prediction of dementia by subjective memory impairment: Effects of severity and temporal association with cognitive impairment. Arch Gen Psychiatry 67, 414-422. Jessen F, Wiese B, Bickel H, Eiffl¨ander-Gorfer S, Fuchs A, Kaduszkiewicz H, K¨ohler M, Luck T, M¨osch E, Pentzek M, Riedel-Heller SG, Wagner M, Weyerer S, Maier W, van den Bussche H (2011) Prediction of dementia in primary care patients. PLoS One 6, e16852. Lin JS, O’Connor E, Rossom RC, Perdue LA, Eckstrom E (2013) Screening for cognitive impairment in older adults: A systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 159, 601-612. Lee JY, Dong Woo L, Cho SJ, Na DL, Hong Jin Jeon, Kim SK, You Ra Lee, Youn JH, Kwon M, Lee JH, Maeng Je Cho (2008) Brief screening for mild cognitive impairment in elderly outpatient clinic: Validation of the Korean version of the Montreal Cognitive Assessment. J Geriatr Psychiatry Neurol 21, 104-110. Markwick A, Zamboni G, de Jager CA (2012) Profiles of cognitive subtest impairment in the Montreal Cognitive Assessment (MoCA) in a research cohort with normal
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[28]
[29]
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Journal of Alzheimer’s Disease xx (20xx) x–xx DOI 10.3233/JAD-142724 IOS Press
3
roo f
2
A Simple Tool to Reach Populations at Risk for Developing Dementia and Alzheimer’s Disease
or P
1
4
Noa Bregmana,∗ , Keren Regeva , Orna Moorea , Nir Giladib,c and Elissa Asha
5
a Memory
6
b Sackler
uth
7
and Attention Disorders Center, Tel Aviv “Sourasky” Medical Center, Tel Aviv, Israel School of Medicine, Tel Aviv University, Tel Aviv, Israel c Department of Neurology, Tel Aviv “Sourasky” Medical Center, Tel Aviv, Israel
Accepted 7 February 2015
15
Keywords: Alzheimer’s disease, dementia, mild cognitive impairment, prevention, screening, subjective cognitive impairment
16
INTRODUCTION
13
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
cte
12
rre
11
The early detection of people who are at risk for developing dementia and Alzheimer’s disease (AD) is one of the major challenges in the field of therapeutic development. Disease modifying medications are still not available for the treatment of AD, thus reaching an early diagnosis is a complicated ethical issue of much debate, Some believe that early diagnosis when symptoms are minimal before the appearance of significant cognitive decline may be beneficial to the patient and his family, while some believe that as long as therapy is not available, people should not be informed of a diagnosis. Expert consensus guidelines state that early detection of cognitive decline can optimize medical management, offer relief based on better understanding of symptoms, maximize decision making autonomy and planning for the future, and
co
10
Un
9
dA
14
Abstract. Identification of individuals at high risk for developing dementia and Alzheimer’s disease is a major challenge. A “memory fair” is an enjoyable and affordable tool designed to reach local population at risk, mainly those with subjective cognitive impairment (SCI) or mild cognitive impairment. The fair included a free cognitive assessment and presentation on the importance of sleep, physical activity, cognitive training, and risk-factors and provided personalized recommendations. 160 individuals completed the evaluation (69.97 ± 9.01 y, 83% women). Average Montreal Cognitive Assessment Score (MoCA) was 24.73 ± 3.71. Six percent reported SCI and an upper estimate of mild cognitive impairment prevalence was 30.7%. SCI was found to be a sensitive predictor for MoCA 25 were referred to their primary care physician for ongoing follow up, and participants with scores of 25 or less were referred for further evaluation and follow-up care with a neurologist. Secondary prevention trials in AD are now being designed and will require documentation of brain amyloidosis for enrollment [27]. The identification of noninvasive, low-cost measures that would reduce the number of subjects needed to be screened using expensive amyloid PET scan or lumbar punctures for cerebrospinal fluid amyloid levels, would greatly improve the efficiency of clinical trials targeting the preclinical disease phase. A recent study that had examined indicators of Pittsburgh compound B (PiB)–PET imaging positivity, found that subjective memory complaints are as good predictors of PiB positivity as cognitive test performance, and that easily obtainable information such as age, sex, APOE genotype, family history of dementia, and subjective memory complaints, would greatly reduce costs of screening and the number of individuals needed to be screened using much more expensive assessments such as brain amyloidosis [28]. We suggest that conducting a “memory fair”, an easily accessible and enjoyable event for the local population, can serve as a simple, relatively low-cost tool to attract people at risk for developing dementia and AD.
[3]
[4]
[5]
[6]
[7]
co
187
Un
186
N. Bregman et al. / The Memory Fair
uth
4
[8] [9]
[10] [11]
[12]
Prince M, Bryce R, Ferri C (2011) World Alzheimer Report 2011. The Benefits of Early Diagnosis and Intervention. Alzheimer’s Disease International, London. Holsinger T, Deveau J, Boustani M, Williams JW Jr (2007) Does this patient have dementia? JAMA 297, 2391-2404. Ganguli M, Rodriguez E, Mulsant B, Richards S, Pandav R, Bilt JV, Dodge HH, Stoehr GP, Saxton J, Morycz RK, Rubin RT, Farkas B, DeKosky ST (2004) Detection and management of cognitive impairment in primary care: The Steel Valley Seniors Survey. J Am Geriatr Soc 52, 1668-1675. Valcour VG, Masaki KH, Curb JD, Blanchette PL (2000) The detection of dementia in the primary care setting. Arch Intern Med 160, 2964-2968. Olafsdottir M, Skoog I, Marcusson J (2000) Detection of dementia in primary care: The Linkoping study. Dement Geriatr Cogn Disord 11, 223-229. Chodosh J, Petitti DB, Elliott M, Hays RD, Crooks VC, Reuben DB, Galen Buckwalter J, Wenger N (2004) Physician recognition of cognitive impairment: Evaluating the need for improvement. J Am Geriatr Soc 52, 1051-1059. Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, Gamst A, Holtzman DM, Jagust WJ, Petersen RC, Snyder PJ, Carrillo MC, Thies B, Phelps CH (2011) The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement 7, 270-279. Petersen RC (2004) Mild cognitive impairment as a diagnostic entity. J Intern Med 256, 183-194. Bennett DA, Wilson RS, Schneider JA, Evans DA, Beckett LA, Aggarwal NT, Barnes LL, Fox JH, Bach J (2002) Natural history of mild cognitive impairment in older persons. Neurology 59, 198-205. Iliffe S, Pealing L (2010) Subjective memory problems. BMJ 340, c1425. Jonker C, Geerlings MI, Schmand B (2000) Are memory complaints predictive for dementia? A review of clinical and population-based studies. Int J Geriatr Psychiatry 15, 983991. Amariglio RE, Townsend MK, Grodstein F, Sperling RA, Rentz DM (2011) Specific subjective memory complaints in older persons may indicate poor cognitive function. J Am Geriatr Soc 59, 1612-1617.
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Mini-Mental State Examination (MMSE) scores. J Clin Exp Neuropsychol 34, 750-757. Athilingam P, King KB, Burgin SW, Ackerman M, Cushman LA, Chen L (2011) Montreal Cognitive Assessment and MiniMental Status Examination compared as cognitive screening tools in heart failure. Heart Lung 40, 521-529. Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, Nordberg A, B¨ackman L, Albert M, Almkvist O, Arai H, Basun H, Blennow K, de Leon M, DeCarli C, Erkinjuntti T, Giacobini E, Graff C, Hardy J, Jack C, Jorm A, Ritchie K, van Duijn C, Visser P, Petersen RC (2004) Mild cognitive impairment–beyond controversies, towards a consensus: Report of the International Working Group on Mild Cognitive Impairment. J Intern Med 256, 240-246. Busse A, Hensel A, Guhne U, Angermeyer MC, Riedel-Heller SG (2006) Mild cognitive impairment: Long-term course of four clinical subtypes. Neurology 67, 2176-2185. Petersen RC, Roberts RO, Knopman DS, Geda YE, Cha RH, Pankratz VS, Boeve BF, Tangalos EG, Ivnik RJ, Rocca WA (2010) Prevalence of mild cognitive impairment is higher in men. The Mayo Clinic Study of Aging. Neurology 75, 889897. Visser PJ, Verhey F, Knol DL, Scheltens P, Wahlund LO, Freund-Levi Y, Tsolaki M, Minthon L, Wallin AK, Hampel H, B¨urger K, Pirttila T, Soininen H, Rikkert MO, Verbeek MM, Spiru L, Blennow K (2009) Prevalence and prognostic value of CSF markers of Alzheimer’s disease pathology in patients with subjective cognitive impairment or mild cognitive impairment in the DESCRIPA study: A prospective cohort study. Lancet Neurol 8, 619-627. Sperling RA, Jack CR Jr, Aisen PS (2011) Testing the right target and right drug at the right stage. Sci Transl Med 3, 111cm133. Mielke MM, Wiste HJ, Weigand SD, Knopman DS, Lowe VJ, Roberts RO, Geda YE, Swenson-Dravis DM, Boeve BF, Senjem ML, Vemuri P, Petersen RC, Jack CR Jr (2012) Indicators of amyloid burden in a population-based study of cognitively normal elderly. Neurology 79, 1570-1577. Barnes DE, Yaffe K (2011) The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurol 10, 819-828.
dA
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[22]
[27]
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Cooper C, Bebbington P, Lindesay J, Meltzer H, McManus S, Jenkins R, Livingston G (2011) The meaning of reporting forgetfulness: A cross-sectional study of adults in the English 2007 Adult Psychiatric Morbidity Survey. Age Ageing 40, 711-717. Reid LM, Maclullich AM (2006) Subjective memory complaints and cognitive impairment in older people. Dement Geriatr Cogn Disord 22, 471-485. Palmer K, Backman L, Winblad B, Fratiglioni L (2003) Detection of Alzheimer’s disease and dementia in the preclinical phase: Population based cohort study. BM 326, 245. Mitchell AJ (2008) The clinical significance of subjective memory complaints in the diagnosis of mild cognitive impairment and dementia: A meta-analysis. Int J Geriatr Psychiatry 23, 1191-1202. Jessen F, Wiese B, Bachmann C, Eifflaender-Gorfer S, Haller F, K¨olsch H, Luck T, M¨osch E, van den Bussche H, Wagner M, Wollny A, Zimmermann T, Pentzek M, RiedelHeller SG, Romberg HP, Weyerer S, Kaduszkiewicz H, Maier W, Bickel H (2010) Prediction of dementia by subjective memory impairment: Effects of severity and temporal association with cognitive impairment. Arch Gen Psychiatry 67, 414-422. Jessen F, Wiese B, Bickel H, Eiffl¨ander-Gorfer S, Fuchs A, Kaduszkiewicz H, K¨ohler M, Luck T, M¨osch E, Pentzek M, Riedel-Heller SG, Wagner M, Weyerer S, Maier W, van den Bussche H (2011) Prediction of dementia in primary care patients. PLoS One 6, e16852. Lin JS, O’Connor E, Rossom RC, Perdue LA, Eckstrom E (2013) Screening for cognitive impairment in older adults: A systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 159, 601-612. Lee JY, Dong Woo L, Cho SJ, Na DL, Hong Jin Jeon, Kim SK, You Ra Lee, Youn JH, Kwon M, Lee JH, Maeng Je Cho (2008) Brief screening for mild cognitive impairment in elderly outpatient clinic: Validation of the Korean version of the Montreal Cognitive Assessment. J Geriatr Psychiatry Neurol 21, 104-110. Markwick A, Zamboni G, de Jager CA (2012) Profiles of cognitive subtest impairment in the Montreal Cognitive Assessment (MoCA) in a research cohort with normal
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[29]
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