Cargando…

Alzheimer’s Disease Assessment Scale–Cognitive subscale variants in mild cognitive impairment and mild Alzheimer’s disease: change over time and the effect of enrichment strategies

BACKGROUND: Development of new treatments for Alzheimer’s disease (AD) has broadened into early interventions in individuals with modest cognitive impairment and a slow decline. The 11-item version of the Alzheimer’s Disease Assessment Scale–Cognitive subscale (ADAS-Cog) was originally developed to...

Descripción completa

Detalles Bibliográficos
Autores principales: Podhorna, Jana, Krahnke, Tillmann, Shear, Michael, E Harrison, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4751673/
https://www.ncbi.nlm.nih.gov/pubmed/26868820
http://dx.doi.org/10.1186/s13195-016-0170-5
_version_ 1782415628108300288
author Podhorna, Jana
Krahnke, Tillmann
Shear, Michael
E Harrison, John
author_facet Podhorna, Jana
Krahnke, Tillmann
Shear, Michael
E Harrison, John
author_sort Podhorna, Jana
collection PubMed
description BACKGROUND: Development of new treatments for Alzheimer’s disease (AD) has broadened into early interventions in individuals with modest cognitive impairment and a slow decline. The 11-item version of the Alzheimer’s Disease Assessment Scale–Cognitive subscale (ADAS-Cog) was originally developed to measure cognition in patients with mild to moderate AD. Attempts to improve its properties for early AD by removing items prone to ceiling and/or by adding cognitive measures known to be impaired early have yielded a number of ADAS-Cog variants. Using Alzheimer’s Disease Neuroimaging Initiative data, we compared the performance of the 3-, 5-, 11- and 13-item ADAS-Cog variants in subjects with early AD. Given the interest in enrichment strategies, we also examined this aspect with a focus on cerebrospinal fluid (CSF) markers. METHODS: Subjects with mild cognitive impairment (MCI) and mild AD with available ADAS-Cog 13 and CSF data were analysed. The decline over time was defined by change from baseline. Direct cross-comparison of the ADAS-Cog variants was performed using the signal-to-noise ratio (SNR), with higher values reflecting increased sensitivity to detect change over time. RESULTS: The decline over time on any of the ADAS-Cog variants was minimal in subjects with MCI. Approximately half of subjects with MCI fulfilled enrichment criteria for positive AD pathology. The impact of enrichment was detectable but subtle in MCI. The annual decline in mild AD was more pronounced but still modest. More than 90 % of subjects with mild AD had positive AD pathology. SNRs were low in MCI but greater in mild AD. The numerically largest SNRs were seen for the ADAS-Cog 5 in MCI and for both the 5- and 13-item ADAS-Cog variants in mild AD, although associated confidence intervals were large. CONCLUSIONS: The possible value of ADAS-Cog expansion or reduction is less than compelling, particularly in MCI. In mild AD, adding items known to be impaired at early stages seems to provide more benefit than removing items on which subjects score close to ceiling. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13195-016-0170-5) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-4751673
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-47516732016-02-13 Alzheimer’s Disease Assessment Scale–Cognitive subscale variants in mild cognitive impairment and mild Alzheimer’s disease: change over time and the effect of enrichment strategies Podhorna, Jana Krahnke, Tillmann Shear, Michael E Harrison, John Alzheimers Res Ther Research BACKGROUND: Development of new treatments for Alzheimer’s disease (AD) has broadened into early interventions in individuals with modest cognitive impairment and a slow decline. The 11-item version of the Alzheimer’s Disease Assessment Scale–Cognitive subscale (ADAS-Cog) was originally developed to measure cognition in patients with mild to moderate AD. Attempts to improve its properties for early AD by removing items prone to ceiling and/or by adding cognitive measures known to be impaired early have yielded a number of ADAS-Cog variants. Using Alzheimer’s Disease Neuroimaging Initiative data, we compared the performance of the 3-, 5-, 11- and 13-item ADAS-Cog variants in subjects with early AD. Given the interest in enrichment strategies, we also examined this aspect with a focus on cerebrospinal fluid (CSF) markers. METHODS: Subjects with mild cognitive impairment (MCI) and mild AD with available ADAS-Cog 13 and CSF data were analysed. The decline over time was defined by change from baseline. Direct cross-comparison of the ADAS-Cog variants was performed using the signal-to-noise ratio (SNR), with higher values reflecting increased sensitivity to detect change over time. RESULTS: The decline over time on any of the ADAS-Cog variants was minimal in subjects with MCI. Approximately half of subjects with MCI fulfilled enrichment criteria for positive AD pathology. The impact of enrichment was detectable but subtle in MCI. The annual decline in mild AD was more pronounced but still modest. More than 90 % of subjects with mild AD had positive AD pathology. SNRs were low in MCI but greater in mild AD. The numerically largest SNRs were seen for the ADAS-Cog 5 in MCI and for both the 5- and 13-item ADAS-Cog variants in mild AD, although associated confidence intervals were large. CONCLUSIONS: The possible value of ADAS-Cog expansion or reduction is less than compelling, particularly in MCI. In mild AD, adding items known to be impaired at early stages seems to provide more benefit than removing items on which subjects score close to ceiling. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13195-016-0170-5) contains supplementary material, which is available to authorized users. BioMed Central 2016-02-12 /pmc/articles/PMC4751673/ /pubmed/26868820 http://dx.doi.org/10.1186/s13195-016-0170-5 Text en © Podhorna et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Podhorna, Jana
Krahnke, Tillmann
Shear, Michael
E Harrison, John
Alzheimer’s Disease Assessment Scale–Cognitive subscale variants in mild cognitive impairment and mild Alzheimer’s disease: change over time and the effect of enrichment strategies
title Alzheimer’s Disease Assessment Scale–Cognitive subscale variants in mild cognitive impairment and mild Alzheimer’s disease: change over time and the effect of enrichment strategies
title_full Alzheimer’s Disease Assessment Scale–Cognitive subscale variants in mild cognitive impairment and mild Alzheimer’s disease: change over time and the effect of enrichment strategies
title_fullStr Alzheimer’s Disease Assessment Scale–Cognitive subscale variants in mild cognitive impairment and mild Alzheimer’s disease: change over time and the effect of enrichment strategies
title_full_unstemmed Alzheimer’s Disease Assessment Scale–Cognitive subscale variants in mild cognitive impairment and mild Alzheimer’s disease: change over time and the effect of enrichment strategies
title_short Alzheimer’s Disease Assessment Scale–Cognitive subscale variants in mild cognitive impairment and mild Alzheimer’s disease: change over time and the effect of enrichment strategies
title_sort alzheimer’s disease assessment scale–cognitive subscale variants in mild cognitive impairment and mild alzheimer’s disease: change over time and the effect of enrichment strategies
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4751673/
https://www.ncbi.nlm.nih.gov/pubmed/26868820
http://dx.doi.org/10.1186/s13195-016-0170-5
work_keys_str_mv AT podhornajana alzheimersdiseaseassessmentscalecognitivesubscalevariantsinmildcognitiveimpairmentandmildalzheimersdiseasechangeovertimeandtheeffectofenrichmentstrategies
AT krahnketillmann alzheimersdiseaseassessmentscalecognitivesubscalevariantsinmildcognitiveimpairmentandmildalzheimersdiseasechangeovertimeandtheeffectofenrichmentstrategies
AT shearmichael alzheimersdiseaseassessmentscalecognitivesubscalevariantsinmildcognitiveimpairmentandmildalzheimersdiseasechangeovertimeandtheeffectofenrichmentstrategies
AT eharrisonjohn alzheimersdiseaseassessmentscalecognitivesubscalevariantsinmildcognitiveimpairmentandmildalzheimersdiseasechangeovertimeandtheeffectofenrichmentstrategies
AT alzheimersdiseaseassessmentscalecognitivesubscalevariantsinmildcognitiveimpairmentandmildalzheimersdiseasechangeovertimeandtheeffectofenrichmentstrategies