[A simple three-step model for detection of preclinical dementia among the elderly].
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Biomedical subjects
Lars Bäckman
Publications and source records attributed to Lars Bäckman.
Detection of Alzheimer's disease and dementia in the preclinical phase: population based cohort study.
OBJECTIVES: To evaluate a simple three step procedure to identify people in the general population who are in the preclinical phase of Alzheimer's disease and dementia. DESIGN: Three year population based cohort study. SETTING: Kungsholmen cohort, Stockholm, Sweden. PARTICIPANTS: 1435 people aged 75-95 years without dementia. ASSESSMENTS: Single question asking about memory complaints, assessment by mini-mental state examination, and neuropsychological testing. MAIN OUTCOME MEASURE: Alzheimer's disease and dementia at three year follow up. RESULTS: None of the three instruments was sufficiently predictive of Alzheimer's disease and dementia when administered separately. After participants had been screened for memory complaints and global cognitive impairment, specific tests of word recall and verbal fluency had positive predictive values for dementia of 85-100% (95% confidence intervals range from 62% to 100%). However, only 18% of future dementia cases were identified in the preclinical phase by this three step procedure. Memory complaints were the most sensitive indicator of Alzheimer's disease and dementia in the whole population, but only half the future dementia cases reported memory problems three years before diagnosis. CONCLUSION: This three step procedure, which simulates what might occur in clinical practice, has a high positive predictive value for dementia, although only a small number of future cases can be identified.
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Cognitive deficits in preclinical Alzheimer's disease.
We review the literature on cognitive functioning during the transition from normal aging to clinical Alzheimer's disease (AD). There is ample empirical evidence that deficits across multiple cognitive domains are apparent years to decades before the AD diagnosis, with impairments in episodic memory representing a common cognitive manifestation of the preclinical phase of the disease. Interestingly, the magnitude of the preclinical cognitive deficits appears to be relatively stable until a few years before clinical diagnosis. The behavioural deficits associated with preclinical AD are consistent with the neural changes that appear many years before eventual diagnosis. In addition to increasing our theoretical understanding of AD development, research on cognition in preclinical AD contributes to the identification of persons at risk of developing AD for purposes of intervention.
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Selective adult age differences in an age-invariant multifactor model of declarative memory.
Confirmatory factor analysis was used to test competing models of declarative memory. Data from middle-aged participants provided support for a model comprised of 2 2nd-order (episodic and semantic memory) and 4 1st-order (recall, recognition, fluency, and knowledge) factors. Extending this model across young-old and old-old participants established support for age invariance. Tests of group differences showed an age deficit in episodic memory that was more pronounced for recall than for recognition. For semantic memory, there was an increase in knowledge from middle to young-old age and thereafter a decrease. Overall, the results support the view that episodic memory is more age sensitive than semantic memory, but they also indicate that aging has differential effects within these 2 forms of memory.
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Terminal decline and cognitive performance in very old age: does cause of death matter?
Cross-sectional differences and longitudinal changes in cognitive functioning in relation to mortality across a 7-year follow-up period, with 3 times of measurement, were examined in a population-based sample of very old adults. The authors also sought to determine whether cause of death (cerebro/cardiovascular disease [CVD]; non-CVD) modified the magnitude of mortality-related cognitive deficits. Cognitive performance was indexed by tests of general cognitive ability, episodic memory, primary memory, verbal fluency, and visuospatial ability. Results indicated cross-sectional differences on all domains of functioning, with persons who would die within 3 years after baseline testing performing more poorly. Longitudinally, greater decrements were observed on all domains for persons who would die after the first follow-up period, as compared with survivors. Cause of death failed to modify the magnitude of the cross-sectional and longitudinal deficits. The pattern of results point to the general nature of this phenomenon.
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Self-reported memory compensation: similar patterns in Alzheimer's disease and very old adult samples.
Evidence pertaining to self-reported use of memory compensation techniques was collected using the Memory Compensation Questionnaire (MCQ). Five forms of everyday memory compensation were evaluated: (a) external memory aids, (b) internal mnemonic strategies, (c) investing and managing processing time, (d) applying more effort, and (e) reliance on human memory aids. The sample was derived from the Kungsholmen Project in Stockholm, Sweden, and consisted of (n = 85) healthy older adults (M age = 81.80 years; M MMSE = 28.34) and (n = 21) diagnosed Alzheimer's Disease (AD) patients (Mage = 81.80 years; M MMSE = 23.55). Participants were tested on two occasions, 6 months apart. Results showed that the MCQ was a largely reliable instrument in these two groups. Moreover, we observed substantial sample similarity in frequency of using the five forms of everyday memory compensation techniques. The healthy sample reported using the external techniques more than the AD sample. Over the 6-month interval, however, AD patients differentially increased their use of others to assist them in everyday memory performance. Results are interpreted in terms of insight into changes in memory skills and inthe implementation of effective memory support systems.
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Cigarette smoking and cognitive performance in healthy Swedish adults.
BACKGROUND: The relationship between cigarette smoking and cognitive function was examined in healthy Swedish adults who were participants in the Betula Prospective Cohort Study of Aging, Memory, and Health. SUBJECTS: The data are from those individuals in the Betula study who were self-reported continuous smokers contrasted to those who reported never smoking cigarettes. DESIGN: The dependent variables were cognitive tasks that varied with respect to difficulty and the demand they placed on processing resources. RESULTS: Current smokers performed more poorly than never smokers on the more cognitively demanding tasks; namely, Block Design and free recall. CONCLUSIONS: The findings were interpreted in the light of the assumption that cigarette smoking may exert its greatest deleterious effect on those cognitive tasks that place the heaviest demands on processing resources.
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Use of memory compensation strategies is related to psychosocial and health indicators.
Research has shown that psychosocial and health characteristics may affect older adults' cognitive performance, self-referent beliefs, and general adaptive resilience. Are such characteristics related specifically to older adults' reported efforts to compensate for memory losses? The Memory Compensation Questionnaire (MCQ) measures 5 mechanisms of everyday memory compensation as well as 2 general aspects of compensatory motivation and awareness. Correlates were derived from indicators of specific health conditions, subjective health ratings, personality, well-being, and memory self-efficacy (MSE). All measures were administered to a cross-sectional sample of 528 healthy older adults between 55 and 94 years of age from the Victoria Longitudinal Study. Specific health composites (i.e., infirmities, respiratory illness), several personality dimensions (e.g., agreeableness, neuroticism), negative affect, and low MSE were associated with more frequent use of everyday memory compensation strategies. Linking healthy older adults' cognitive resilience with individual characteristics is an important contribution to emerging conceptions of adaptation and success in late life.
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Rate of cognitive decline in preclinical Alzheimer's disease: the role of comorbidity.
We investigated the influence of individual-difference variables implicated as risk factors for Alzheimer's disease (AD) or known to be related to cognitive performance in normal aging (e.g., age, sex, years of education, previous and recent diseases, apolipoprotein E status, social network, and substance use) on rate of cognitive change from preclinical to clinical AD. With the use of data from a population-based study, 230 persons who were nondemented at baseline and diagnosed with AD at a 3-year follow-up were examined with the Mini-Mental State Examination (MMSE). Of all predictor variables examined, only number of diseases resulting in hospital admission during the follow-up period made an independent contribution to rate of MMSE change. These results suggest that many variables affecting the onset of the degenerative process as well as cognitive functioning in normal aging exert little influence on rate of cognitive change in preclinical AD. This may reflect the fact that the emerging dementia disease overshadows the role of these variables for cognitive functioning. A possible exception to this pattern is that an increasing number of concomitant health conditions may exacerbate the rate of cognitive decline during the final portion of the preclinical phase in AD.
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Genetic variation in memory functioning.
On the basis of a review of the literature the contribution of genetic factors for individual differences in memory performance is discussed. Explorations of such influences on memory have just begun. Most of those studies that have been conducted in order to find a quantitative trait locus for memory have focused on ApolipoproteinE (ApoE). One form of this gene is strongly associated with cardiovascular disease in middle age and to late-onset Alzheimer's disease. Some studies have demonstrated an association between ApoE and memory even in non-demented individuals. Other studies have failed to demonstrate this association. Based on data from a prospective cohort study (Betula) in our own laboratory, we have assessed and examined associations between three different forms of ApoE and performance on episodic memory tests. Cross-sectional comparisons revealed non-significant differences in episodic memory performance between carriers of the three alleles. Analyses of change scores in longitudinal data revealed that allele epsilon 4 was related to a lower level of memory performance than alleles epsilon 2 and epsilon 3. This effect was most pronounced in tasks providing cognitive support at both encoding and retrieval, suggesting a deficit in utilizing such support in carriers of the epsilon 4 allele.
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Differential sex effects in olfactory functioning: the role of verbal processing.
We investigated sex difference across a number of olfactory tasks. Thirty-six men and 35 women ranging in age from 19 to 36 years were assessed in 6 different tasks: absolute sensitivity for n-butanol, intensity discrimination, quality discrimination, episodic recognition memory for familiar and unfamiliar odors, and odor identification. No sex differences were observed in the tasks tapping primarily sensory acuity (i.e., odor sensitivity, intensity discrimination, and quality discrimination) or in episodic memory for unfamiliar odors. By contrast, women outperformed men in the tasks involving verbal processing (i.e., memory for familiar odors and odor identification). Interestingly, controlling for odor naming ability resulted in that the observed sex difference in episodic odor memory for familiar odors disappeared. This outcome suggests that women's superiority in episodic odor memory is largely mediated by their higher proficiency in odor identification.
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Influences of preclinical dementia and impending death on the magnitude of age-related cognitive deficits.
The authors examined the influence of preclinical dementia and impending death on the cross-sectional relationship between age and performance in tasks assessing episodic memory, visuospatial skill, and verbal fluency. Increasing age was associated with a general decrease in cognitive performance. In addition, those who were to be diagnosed with dementia or had died by a 3-year follow-up, were older, and performed at a lower level than the remaining sample across all cognitive tasks at baseline. Nevertheless, removal of the preclinical dementia and impending death groups from the original sample affected the cross-sectional age-cognition relations relatively little. This pattern of findings suggests that the biological aging process exerts negative influences on cognitive functioning beyond those resulting from disease and mortality.
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Liver transplant recipients' ability to cope during the first 12 months after transplantation--a prospective study.
Little is known about the coping style and coping strategies among liver transplant recipients. The aim of this study was to evaluate the change in the sense of coherence and coping strategies among liver transplant recipients before and during the first year after liver transplantation. The aim was also to study whether or not there was any relationship between the sense of coherence and the coping strategies. Thirty-five patients met the inclusion criteria. Twenty-six-patients gave their verbal consent to participate in this longitudinal study and 21 patients (80%) completed the follow-up study. The Sense of Coherence scale (SOC) was used for investigation of coping style. The Jalowiec Coping Scale (JCS-40) was used to assess general coping behaviour. The Ethics Committee gave approval to perform this study. The group was heterogeneous regarding the change in the sense of coherence with pronounced individual changes in meaningfulness during the first 3 months and in comprehensibility 6-12 months after liver transplantation. The group showed a homogeneous pattern of change in coping strategies. Confrontational coping strategy was commonly used during the period. A relationship was found between comprehensibility and palliative coping. This prospective study indicated that coping style, assessed by the SOC scale, changed primarily at an individual level during the first year after liver transplantation while changes in coping strategies, according to JSC-40, were in common for the group. The usual coping strategy during the first posttransplant year was confrontational coping.
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Cognitive functioning in Alzheimer's disease and vascular dementia: further evidence for similar patterns of deficits.
The purpose of the present study was to examine possible differences in patterns of cognitive performance between population-based samples of Alzheimer's disease (AD; n = 51) and vascular dementia (AD; n = 14) patients between 75 and 96 years of age. The two demented groups were comparable in age, years of education, gender distribution, and severity of dementia. The selection of cognitive tasks (letter and category fluency, Block design, Clock reading and setting, and episodic face recognition) was thought to address some of the inconsistencies in previous research. The main finding was that AD and AD patients were comparable on most tasks, although robust dementia-related deficiencies were found when comparing the results of the demented participants with those of the control participants. These findings suggest that AD and AD may affect several basic cognitive functions in an equal manner.
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Reference values for serum levels of vitamin B12 and folic acid in a population-based sample of adults between 35 and 80 years of age.
OBJECTIVES: To examine folic acid and vitamin B12 status in a group of 1000 persons sampled from the community of Umeå, Sweden, and aged 35, 40, 45, 50, 55, 60, 65, 70, 75 or 80 years. Reference data for folate and age-stratified reference data for vitamin B12 are presented, together with an examination of potential confounders. MEASUREMENTS: All subjects participated in extensive health examinations and interviews, and laboratory blood testing was performed. RESULTS: A series of exclusion criteria were applied, and data from 961 subjects were analysed. Vitamin B12 levels were found to decrease with increasing age, whereas folate levels remained constant across the age span studied. None of the vitamins was found to vary with sex, education, smoking or alcohol consumption, body mass index, prescription-free vitamin supplements, level of haemoglobin, or mean cell volume of erythrocytes. Further, none of these factors was associated with the age-related decrease of vitamin B12 level. CONCLUSIONS: The offered reference ranges should be used only in order to rule out deficiency. For B12 levels, the age of the subject should be considered such that, for elderly people in particular, values above the medians should be considered as indicative of normal vitamin status.
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Negligible effects of depression on verbal and spatial performance in Alzheimer's disease.
We examined whether a diagnosis of depression affects verbal and visuospatial performance in Alzheimer's disease (AD). Using data from a population-based study, persons with AD and depression (AD/D), AD alone and a control group of normal older adults were compared in two tests of verbal ability (category and letter fluency) and two tests of visuospatial skill (block design and clock drawing). As expected, there were clear AD-related deficits across all cognitive tasks. More importantly, the AD and AD/D groups were indistinguishable on all task variables. The lack of effects of depression was discussed relative to the view that those symptoms of this disease which are especially detrimental to cognitive functioning (e.g. concentration difficulties, lack of interest, loss of energy) may already be present in AD as a result of the neurodegenerative process.
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Differential evolution of cognitive impairment in nondemented older persons: results from the Kungsholmen Project.
OBJECTIVE: This study was a prospective, population-based examination of the evolution of cognitive impairment, no dementia (CIND). METHOD: Subjects 75 years old or older living in Stockholm were assessed at baseline and 3 and 6 years later. The severity of CIND was based on age- and education-specific norms on the Mini-Mental State Examination and was classified as mild (N=212), moderate (N=96), or severe (N=57). Mortality, progression to dementia (DSM-III-R), cognitive stability, and cognitive improvement were studied as main outcomes. RESULTS: Of the individuals with mild CIND, 63 (34%) died, 65 (35%) progressed to dementia, 21 (11%) remained stable, and 46 (25%) improved between baseline and first follow-up. The relative risks of progressing to dementia by first follow-up in the subjects with mild, moderate, and severe CIND were 3.6, 5.4, and 7.0, respectively. The relative risk of death decreased with increasing severity of impairment. Individuals who improved at first follow-up did not have a significantly higher risk of later progressing to dementia than subjects who had never been impaired (relative risk=1.4). The absence of a subjective memory complaint predicted improvement (odds ratio=5.4). CONCLUSIONS: CIND is a heterogeneous condition: similar proportions of subjects progress to dementia, death, and cognitive improvement over 3 years. There is no increased future risk of progressing to dementia in CIND subjects who improve during that period.
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