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Biomedical subjects

A U Monsch

Publications and source records attributed to A U Monsch.

At least 19 recordsLinked to original sources
PubMed2005

Frontotemporal dementia, semantic dementia, and Alzheimer's disease: the contribution of standard neuropsychological tests to differential diagnosis.

CERAD-NAB (Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological Assessment Battery) data were compared between 51 patients with frontotemporal dementia, 13 with semantic dementia, and 69 with Alzheimer's disease. There were statistically significant differences between the 3 groups. Compared with patients with Alzheimer's disease, patients with frontotemporal dementia were more impaired on Animal Fluency but not on any other CERAD-NAB subtest. Patients with semantic dementia performed worse in Animal Fluency and Boston Naming Test compared with frontotemporal dementia and Alzheimer's disease. Multiple logistic regression analysis revealed that in the differentiation between frontotemporal dementia and Alzheimer's disease, the combination of Animal Fluency and Boston Naming Test correctly classified 90.5% of patients. In segregating semantic dementia and Alzheimer's disease, the combination of Boston Naming Test and Mini Mental State Examination resulted in a correct classification of 96.3%. These findings demonstrate that the Mini Mental State Examination and the language subtests of the CERAD-NAB are valuable clinical instruments for the differential diagnosis between early frontotemporal dementia, semantic dementia, and Alzheimer's disease.

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PubMed2004

Weight change and cognitive performance.

OBJECTIVE: To investigate whether under- or overweight and weight change is associated with cognitive performance of elderly citizens. DESIGN: Explorative analysis out of the Basel Study cohort. SUBJECTS: In all, 531 healthy subjects (445 men/86 women) were assessed with the Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological Assessment Battery (CERAD-NAB) in 2000 (age: 69.4+/-7.8 y) and weight measurements obtained in 1990 (body mass index (BMI): 25.2+/-3.1 kg/m(2)) and in 2000 (BMI: 25.6+/-3.4 kg/m(2)). METHODS: The predictive power of the annual change in BMI with cognitive performance was investigated by a binary logistic regression analysis (backward) using sex, age, BMI 1990, BMI 2000, diastolic blood pressure, diabetes status, and optimal health status as additional predictors. RESULTS: In the last step, the following variables remained in the model: annual change in BMI (quadratic term; P<0.01); ApoE genotype (P<0.05); and optimal health status (P<0.01). CONCLUSION: The association between the extent of weight change and poorer cognitive performance could be either a consequence of cognitive impairment or an early symptom of neurodegenerative decline.

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PubMed2000

Normal ranges of neuropsychological tests for the diagnosis of Alzheimer's disease.

The diagnosis of early stage dementia is a highly complex process involving not only a somatic examination but also a neuropsychological assessment of the patient's cognitive capability. The American 'Consortium to Establish a Registry for Alzheimer's Disease' (CERAD) has proposed a set of tests in English which has been translated into German. This paper presents the statistical methodology applied to determine normal ranges adjusted for demographic variables for the German CERAD neuropsychological assessment battery (CERAD-NAB). The study population consists of participants of the Basel Study on the Elderly (Project BASEL) which aims at identifying preclinical markers of Alzheimer's disease. The normative sample has been defined by carefully excluding potentially relevant medical history and concomitant diseases and consists of 617 participants which are between 53 and 92 years old. Test results should be adjusted for gender, age, and years of education. For this purpose, a set of linear models including these predictors and subsets of their interactions and squares was evaluated for all 11 test scores derived from the CERAD-NAB battery. Model selection was based on the PRESS (predicted residual sum of squares) statistic. Although a strict application of this criterion selected 6 different models, a slight compromise allowed to fit all test scores by two models. In several tests of the CERAD-NAB many participants achieve maximal scores. Residuals of such test scores are heavily skewed. An arcsine transformation has been tuned to the data, so that residuals are close to a normal distribution, at least for residuals in the lower quartile which is relevant in diagnosing cognitive impairment. Test results are finally presented as z-scores which can be easily compared to a standard normal distribution. The evaluation of the CERAD-NAB is implemented on the Internet and in an Excel application.

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PubMed1999

[Argyrophilic grain disease: differentiation from Alzheimer disease].

Argyrophilic grain disease (AgD) constitutes one cause of late onset dementia and is histologically characterized by the presence of abundant argyrophilic grains and coiled bodies. Both abnormalities are found mainly in limbic structures, among them the sector CA1 of the hippocampus, the entorhinal cortex, and the amygdala. Using appropriate silver staining techniques, they are easily detectable and can easily be distinguished from neurofibrillary lesions of Alzheimer's disease (i.e., tangles and threads). Although the histopathology of AgD is well characterized, the nosological status is still unclear because most cases of AgD are associated with Alzheimer-type changes. For some authors, therefore, AgD is considered a variant of Alzheimer's disease rather than a distinct disease entity. The present review is aimed at presenting argyrophilic grain disease to a larger readership than just neuropathologists who are interested in neurodegenerative disorders. In this review we summarize morphological, immunohistochemical, clinico-pathological and genetic data obtained in more than 90 subjects with AgD. The main conclusions of this review are that AgD represents one of the most frequent, dementing disorders of old age and that it has to be clearly distinguished from Alzheimer's disease.

Alzheimer Disease↗
PubMed1998

Apolipoprotein E allele frequencies in argyrophilic grain disease.

Apolipoprotein E (ApoE) genotypes were analyzed in 35 subjects with argyrophilic grain diseases (AgD). Neuropathologically, all cases were characterized by abundant argyrophilic grains in the hippocampus and in the entorhinal or parahippocampal cortex. We found an ApoE epsilon4 allele frequency of 0.007 in AgD patients, which is significantly different from the epsilon4 allele frequencies reported in age-matched Alzheimer's disease (AD) patients (0.24), but not from age-matched controls (0.09). We conclude that the ApoE epsilon4 allele does not constitute a risk factor for the development of AgD. Our results further suggest that AgD is a progressive disorder differentiated from AD by morphological and genetic criteria.

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PubMed1998

Memory Clinics in Switzerland. Collaborative Group of Swiss Memory Clinics.

Currently, eleven Memory Clinics (MC) in Switzerland offer their services to patients, caregivers and family doctors. Their primary goal is the early diagnosis and management of dementia in elderly outpatients. Special emphasis is put on the detection of reversible causes of dementing disorders. Diagnoses and medical, pharmacological, neuropsychological and social treatment recommendations are established in a multidisciplinary consensus conference and communicated back to the referring physicians. The psychosocial therapies and supportive activities include counseling, memory training for patients, neuropsychological rehabilitation, caregiver groups, relaxation and biofeedback training, day care centers, Alzheimer's Tanzcafé, and special vacations for dementia patients. These activities vary from MC to MC according to the availability of resources. Research activities are an integral part of all MCs and range from the attempt to identify preclinical markers of Alzheimer's disease to studies of neuropathological correlates of cognitive disturbances. Moreover, patients are encouraged to participate in studies investigating new medications. MCs play an important role in the education and training of health care professionals and in raising awareness and support in the general population.

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PubMed1997

[Neuropsychological examination in evaluating dementia].

Neuropsychological assessment of dementia should be obtained using a two-step procedure: 1) a family physician performs a mental screening; 2) specialists determine the diagnosis after a thorough differential diagnostic process. This second step includes the quantitative neuropsychological assessment of the patients' cognitive functions which has the following purposes: a) to contribute to the differential diagnostic process; b) to aid in diagnosing patients at the earliest stage of dementia; c) to document disease progression and therapy outcomes; and, d) to identify relatively intact areas of cognition to serve as a basis for cognitive therapy. A Swiss consensus to utilize the Consortium to Establish a Registry for Alzheimer's disease (CERAD) Neuropsychological Battery as a minimal standard assessment instrument is introduced.

Activities of Daily Living↗
PubMed1997

Argyrophilic grain disease: distribution of grains in patients with and without dementia.

In a previous study we reported on a late onset dementia which occurred in only half of the patients with argyrophilic grain disease (AgD) investigated. To find a correlation between the distribution of argyrophilic grains (ArG) and the occurrence of a late onset dementia, we examined the limbic area in 35 subjects who had ArG as the main neuropathological finding. A retrospective clinical analysis was performed by collecting information from hospital charts supplemented by standardized interviews based on DSM IV criteria for dementia. Sections from the rostral and caudal hippocampal regions, including the entorhinal/transentorhinal and parahippocampal cortex on both sides, were strained by the Gallays method. Nineteen subjects were diagnosed as demented according to these criteria; 16 were considered to have been cognitively normal. High numbers of ArG were observed in the anterior part of the CA1 subfield in all cases. However, the posterior half of CA1 was involved significantly more often and more severely in demented than in non-demented individuals (P < 0.01). Moreover, the distribution of ArG in the entorhinal/transentorhinal and parahippocampal cortex was more widespread in the group of demented patients (P < 0.05). These results show that the intellectual status of patients with AgD was related to the extension of ArG in the limbic area. We suggest that AgD is a progressive neurodegenerative disorder with early subclincial lesions in the anterior part of the hippocampal formation. To provide a more accurate clinicopathological correlation, the rostrocaudal extension of ArG in the limbic area should be evaluated in AgD cases.

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PubMed1997

Early diagnosis of dementia via a two-step screening and diagnostic procedure.

We propose a two-step process for the assessment of dementia using standardized instruments. The family physician performs a screening consisting of taking a medical history, gathering information from relatives and friends of the patient, and administering the combined Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT). Specialists examine patients with suspected dementia to confirm the diagnosis of dementia and, after a thorough differential diagnostic process, provide the family physician with recommendations for treatment. Specialists should perform neurological and psychiatric examinations, imaging (computer-assisted tomography [CT], magnetic resonance imaging [MRI]), and laboratory work-up. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) core neuropsychological battery is proposed to serve as a minimal data set that is internationally compatible. In addition, we recommend the Nurses' Observation Scale for Geriatric Patients (NOSGER) as a standard tool for functional assessment.

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PubMed1997

Category fluency is also predominantly affected in Swiss Alzheimer's disease patients.

OBJECTIVES: To establish the comparative efficacy to differentiate between Swiss patients with dementia of the Alzheimer type (DAT) and elderly normal control subjects (NC) on two different verbal fluency tasks: category fluency and letter fluency. MATERIAL AND METHODS: Fifty Swiss German DAT patients in the early stages of the disease and 50 matched normal control subjects were compared on letter and category fluency tasks. RESULTS: DAT patients exhibited an overproportional impairment on category fluency as compared with letter fluency. Receiver operating characteristic curves (ROC) showed that category fluency correctly classified a significantly higher number of DAT patients and NC subjects (84%) than letter fluency (70%). CONCLUSION: As similar findings have been described for English-speaking DAT patients, we conclude that deficiencies in category fluency are a general phenomenon, reflecting impaired structures of semantic knowledge occurring early in the course of Alzheimer's disease.

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PubMed1996

Random number generation in dementia of the Alzheimer type: a test of frontal executive functions.

The quality of attempts at generating a random sequence of the numbers 1-6 was studied in 30 patients with dementia of the Alzheimer type (DAT) and 30 elderly normal control (NC) subjects. Three main findings emerged: (1) DAT patients' subjective random sequences were more streotyped (contained fewer digit combinations) than those of NC subjects. (2) This difference in response stereotypy was due to patients' enhanced tendency to arrange consecutive numbers in an ascending series ('counting bias'). (3) In the patient group, degree of sequential nonrandomness was positively correlated with overall severity of dementia and with the extent to which performance on neuropsychological tests specifically assessing executive functions (fluency, naming, error monitoring) was impaired. These results illustrate a loss of behavioral complexity in the course of dementia and are interpreted as reflecting a frontal dysexecutive syndrome in DAT.

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PubMed1996

Screening for dementia of the alzheimer type in the community: the utility of the Clock Drawing Test.

This study reports the sensitivity and specificity of the Clock Drawing Test (CDT) for detecting dementia of the Alzheimer type in a community-dwelling sample of elderly subjects. Forty-two patients with clinically diagnosed Alzheimer's disease and 237 cognitively intact subjects were administered the CDT as part of an epidemiological study of aging and dementia. Three individual measures of clock drawing performance (quantitative score, qualitative score, and combined quantitative and qualitative score) were determined for each participant. When qualitative elements such as errors and strategies were incorporated into the CDT score, the sensitivity was 84% and the specificity was 72%. The findings suggest that a CDT score which evaluates qualitative and quantitative features provides reasonably good discrimination between normal elderly individuals and DAT patients. However, the CDT appears to have limited utility as a single screening instrument in the community. Instruments such as the Dementia Rating Scale (Mattis, 1976) provide better discrimination of DAT, indicating that functions such as memory and verbal fluency need to be assessed during screening.

Journal Article↗
PubMed1996

Repetitive behavior and repetition avoidance: the role of the right hemisphere.

Based on clinical observations of patients suffering from brain damage, a recent model assumes a right hemisphere dominance for the suppression of repetitive behavior. This study set out to test whether or not the well-known effect of repetition avoidance in sequential response production is likewise mediated by the right hemisphere. It was found that, in 40 healthy subjects, avoidance of repetitions in a random number-generation task correlated positively with a relative superiority for design as compared to letter fluency. Since design fluency is predominantly mediated by the right frontal lobe and letter fluency by the left, this finding supports the notion of a right hemisphere dominance for the avoidance of repetitive responses. This study illustrates the usefulness of a neurobehavioral approach to repetition behavior in the randomization of response. In particular, it demonstrates that the phenomenon of repetition avoidance may be better accounted for in terms of a control mechanism preventing perservation than by referring to human subjects' "generally biased concept of randomness."

Adult↗
PubMed1995

Folstein vs modified Mini-Mental State Examination in geriatric stroke. Stability, validity, and screening utility.

OBJECTIVE: Two studies were conducted with the Folstein Mini-Mental State Examination (MMS) and the Modified Mini-Mental State Examination (3MS) to examine whether the expanded version is a more useful screening tool in stroke populations. DESIGN: Clinical utility of screening tests (MMS and 3MS) was evaluated in reference to neuropsychological performance and functional outcome in rehabilitation. SETTING: Medical rehabilitation unit of university-affiliated hospital. PATIENTS: Two groups (n = 77, and n = 70) of patients who were admitted consecutively. MAIN OUTCOME MEASURES: Neuropsychological performance and functional outcome (functional independence measure). RESULTS: The reliability, stability, and validity of the 3MS were established in the stroke population. Classification accuracy did not differ between the MMS and 3MS, although the 3MS had higher sensitivity. In detecting cognitive impairment when compared with the extended neuropsychological battery, both instruments were adequate in patients with left-sided cerebrovascular accidents and were ineffective in patients with right-sided cerebrovascular accidents. The 3MS correlated with some cognitive domains missed by the MMS, thus adding useful clinical information. Finally, the 3MS was a significantly better predictor of functional outcome than the MMS. CONCLUSIONS: The 3MS was found to be a reliable, valid, and stable cognitive screening instrument in the stroke population. Classification accuracy indicates that both screening instruments are not strong in their ability to detect cognitive impairment in patients with stroke, especially in right-sided cerebrovascular accidents. The 3MS does have some advantages over the MMS; the expanded version of the screen not only provides additional cognitive information but also allows for better predicting of functional outcome.

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PubMed1995

Clinical validity of the Mattis Dementia Rating Scale in detecting Dementia of the Alzheimer type. A double cross-validation and application to a community-dwelling sample.

OBJECTIVE: To assess the clinical validity of the Dementia Rating Scale (DRS) in detecting patients with dementia of the Alzheimer type (DAT). BACKGROUND: The DRS is widely used to evaluate cognitive functioning in older adults. Adequate normative data are unavailable; studies addressing the clinical validity of the DRS are limited by small sample sizes. DESIGN AND METHODS: Administered the DRS to 254 outpatients with DAT and 105 healthy elderly subjects. Performed (1) multiple regressions of demographic factors on the DRS and its subscales; (2) derivation of optimal DRS cutoff scores using receiver operating characteristic curves; (3) double cross-validation with stepwise logistic regressions; and (4) application of results to a community-dwelling sample. RESULTS: Age- and education-adjusted DRS scores were computed. The optimal DRS cutoff score for DAT of 129 or less revealed a sensitivity of 98% and a specificity of 97%. The logistic regressions resulted in a combination of the Memory and Initiation/Perseveration subscales that correctly classified 98% of all subjects, 92% of a subsample of 76 patients with mild DAT, and 100% of the 51 patients with autopsy-confirmed DAT. The resultant equation was then applied to a community-dwelling sample (238 healthy elderly subjects and 44 patients with DAT): 91% of patients and 93% of normal subjects were correctly classified. Of an additional 77 individuals with questionable DAT, 43 were classified as demented and 34 were classified as nondemented. CONCLUSIONS: The DRS is a clinically valid psychometric test for the detection of DAT. The Memory and Initiation/Perseveration subscales are its best discriminative indexes for an abbreviated version.

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PubMed1995

Discrimination of cortical from subcortical dementias on the basis of memory and problem-solving tests.

This study compared the discriminative utility of problem-solving and memory tasks in patients with Alzheimer's and Huntington's disease and in age-, education-, and gender-matched normal control subjects. Problem-solving was assessed with a modified version of the Wisconsin Card Sorting Test. Memory was measured with a 10-item, 6-trial version of the Buschke Selective Reminding Test. Receiver Operating Characteristic curves were plotted to determine which measure provided the highest sensitivity (i.e., hit rate) and specificity (i.e., correct rejection rate). Both tests provided excellent detection of dementia (88 to 98% classification accuracy), but were less robust in differentiating between dementia groups. Findings underscore the suitability of both measures to detect mild dementia, but emphasize the importance of specific memory measures to differentiate between cortical and subcortical dementia.

Adult↗
PubMed1995

Neuropsychological studies of asymptomatic human immunodeficiency virus-type-1 infected individuals. The HNRC Group. HIV Neurobehavioral Research Center.

The current review was conducted to address the ongoing debate regarding the presence or absence of neuropsychological impairment in asymptomatic HIV-Type 1 (HIV-1) seropositive individuals. Results were summarized from 57 studies that compared the performances of seropositive asymptomatic and seronegative individuals. Overall, the differences observed between median rates of impairment for asymptomatic (35%) and seronegative (12%) groups provided the clearest indication of deficits in asymptomatics. In addition, five variables were examined as possible contributors to inconsistencies found in the literature: mode of infection, test battery type, test battery size, sample size, and method of data analysis. Of these variables, only mode of infection and test battery size appeared to substantially influence the outcome of the studies reviewed with regard to identifying neuropsychological impairment in asymptomatics.

AIDS Dementia Complex↗