Eleni Tsantali

Could language deficits really differentiate Mild Cognitive Impairment (MCI) from mild Alzheimer's disease?

Naming abilities seem to be affected in Alzheimers disease (AD) patients, though MCI individuals tend to exhibit greater impairments in category fluency. In this study we: (1) detect language deficits of amnestic MCIs (aMCIs) and mild AD (mAD) participants and present their language performance (the Boston Diagnostic Aphasia Examination - BDAE scores) according to educational level, (2) study the diagnostic value of language deficits according to the cognitive state of the participants. One hundred nineteen participants, 38 normal controls (NC), 28 aMCIs and 53 mADs, were recruited randomly as outpatients of 2 clinical departments and administered clinical, neuropsychological and neuroimaging assessment. Language abilities were assessed by the adapted Greek edition of the BDAE (2nd edition). Our results indicate that verbal fluency, auditory, reading comprehension and narrative ability are the main language abilities to be affected in mADs, although they are almost intact in NCs and less vulnerable in aMCIs. Narrative ability seems to be significantly impaired in mADs but not so in aMCIs. Six language subtests of the BDAE assess safely the above deficits. This brief version of the BDAE discriminated mADs from the other 2 groups 92.5% of the time, NCs 86.8% and aMCI 67.9% of the time in order to save time and to be accurate in clinical practice.

The AQT© as a useful short screening test for dementia. Evidence from two European cultures

Background: Alzheimer s disease (AD) is the most common cause of dementia in the growing elderly population in many countries. The quests for symptomatic relief and prospects of pharmacological treatments of AD, call for sensitive and reliable screening tests which can be easily used by general practitionares in different countries and cultural settings. General criteria for such screening tests should include easy administration and unequivocal scoring, and independence of factors known to be related to cultural settings and educational level. The AQT is a novel screening test designed to assess cognitive processing speed. Three sets of universal stimuli are presented to patients in a fixed protocol. The administration takes 3 5 minutes and the clinical outcome measure is the time (seconds) it takes to perform the test. The AQT is standardised and validated in the USA and in Sweden. It is used by general practitionares and hospital staff throughout Sweden as a supplementary test to the MMSE in the assessment of dementia. Objective(s): We performed a collaborative research study between two European countries, Sweden and Greece, in order to establish the validity and reliability of the AQT, and to further evaluate whether test results meet the criteria of being independent of language and educational level. Methods: The Swedish participants were 97 patients with AD, and 59 healthy subjects, while the Greek participants were 75 patients with AD, and 29 healthy subjects, respectively. All patients met the NINCDS-ADRDA and the DSM-IV criteria for dementia. The patients educational level ranged from 2 to 17 years, MMSE: mean 22.6. The AQT and the MMSE were assessed in all subjects by experienced psychiatrists and neuropsychologists in routine clinical settings in both countries. The discriminatory values of the AQT and the MMSE for the two countries is presented in the Table. Conclusions: The results demonstrate that cognitive processing speed is a general and very sensitive measure which clearly separates mild dementia from normal aging. The usefulness of the AQT in dementia assessment is suggested by the striking similarity of findings in different cultural settings.

Comparison of cognitive performance in mild cognitive impairment and dementia patients with that in normal children and adults

Background:  It is well known that there is rapid cognitive development in childhood and cognitive decline during aging, but the volume of these changes using the same clinical tool is not well documented in the literature. The aim of our study was to investigate and compare the cognitive performance of mild cognitive impairment (MCI) and dementia patients with that of children, adolescents and adults, using a worldwide screening tool, the Mini Mental State Examination (MMSE), and considering the age, educational level and mental status of the participants.

Implications of a Longitudinal Cognitive Intervention Program in Mild Alzheimer’s Disease

The implications of a longitudinal (5 years) intervention program in a mild Alzheimers disease (mAD) patient targeting mainly the language deficits were investigated. The program had 2 parts: the intensive one included training strategies and tasks that enhanced his impairments (memory, naming, comprehension), and the second one (the next 4 years), without guidelines or teaching. The first follow up (11 months later) showed significant improvements to memory, categorical verbal fluency, comprehension and written narrative ability even to untrained functions (behavior and functional ability). The second follow up (5 years later) showed retained improvement to delayed memory tasks, language and general cognitive state. Long life cognitive programs retrograde the mAD and seem to maintain the independence of the patient and make remote the possibility of the institutionalization.

The retrogression of the Alzheimer's disease for 5 years through a cognitive rehabilitation intervention. A case report

Materials and methods The patient met the DSM-IV and NINCDS-ADRDA criteria. Laboratory, neuroimaging exams and detailed neuropsychological assessment were also performed. The neuroimaging data (MRI) showed atrophy of hippocampus and hypometabolism (SPECT) in temporal, parietal and frontal cortical areas. The formal diagnosis was probable Alzheimers disease. We scheduled an individual cognitive intervention program 5 days a week for 4 months. A follow up, 6 months after the end of the program, showed a clinical and neuropsychological image compatible to normal aging. The following 4 years he was doing cognitive exercises for one hour, 3 times a week. During this program the patient was also treated with a cholinesterase inhibitor.

Practice of Competence Assessment in Dementia: Greece

Currently, dementia in Greece is unfortunately not even recognised as a type of disability. There is no legislative frame, not even any mention of the term “dementia”. The legal system refers only to patients with psychiatric disorders and other categories of people who are not demented. In addition, psychiatric and demented patients are confronted by the legislation of legal guardianship. This law aims to keep the disability patients active and functional because of the respect of their personality. Close relatives need a lawyer in order to deposit the application form of legal guardianship in Court and the closest relative will be proposed as temporary and definitive legal guardian, although other relatives (not more than 3) will be proposed as members of the supervisory council. The legislation anticipates similar self-appointed confrontation for the patients who are alone or abandoned or who have no relatives or other caregivers. However, there are always judicial debates among the closest relatives for the financial resources management and especially in cases involving many children.

Do functional disability is a good predictor index for Alzheimer's disease?

Materials and methods 29 mild DAT patients were included in this study. The mean of age and educational level was 73.2 and 9.4 years respectively, though the mean of mental state as measured by MMSE was 23.7/30. All the patients had an established diagnosis of DAT according to the criteria of the DSM-IV and the NINCDS-ADRDA, as well as based on neurological, neuropsychological and neuroimaging data. We administered the Disability Assessment for Dementia Scale (DAD) (Gauthier and Gilinas, 1999) which is a caregiverbased interview comprised of a 40-item questionnaire to evaluate basic and instrumental ADLs in dementia.

The Alzheimer's patients ... do learn!

Background Cognitive disorders are of the main deficits in the first stages of dementia of Alzheimers type (DAT). Memory deficits are obviously as DAT patients delete almost immediately new information and have encode and recall processing impairment. Basing on the new scientific data for neuroplasticity and neurogenesis of the elderly brain we used a memory intervention program in order to help mild DAT patients to improve their mental state.

P4-221: Subjective caregivers’ burden of mild cognitive impairment and Alzheimer’s disease patients

Background: Increased public attention to the problems of Alzheimer’s disease (AD) is not only due to its devastating effect in patients’ personality and cognition but also to its impact on their families. Symptoms of psychological distress among caregivers of AD patients have been early described. Objective(s): To describe the variety of caregivers’ emotions for Mild Cognitive Impairment (MCI) and AD patients and their emotions’ changes while AD patients’ cognitive decline continues. Methods: Participants were recruited from Outpatient Memory and Dementia Clinic. The sample comprised 105 caregivers, 40 of them taking care of AD patients and 65 MCI patients. Diagnosis of AD dementia was based on NINCDSADRDA criteria and MCI diagnosis required evidence of cognitive deficit without evidence of functional impairment. Although MCI subjects’ relatives cannot be regarded officially as caregivers they are referred to as “caregivers” in favor of simplicity. Neuropsychiatric Inventory (NPI) was used to describe patients’ behavioral disorders. Burden Interview (BI) was included to assess caregivers’ stress associated with caregiving (Zarit et al;1980). Statistical analysis used Factor Analysis for BI, Pearson’s correlation and Regression Analysis. Results: Factor Analysis indicated 6 factors, each of them corresponding to a separate emotional source of burden: caregiver’s personal needs, changes in caregiver’s social relations, patient’s disabilities, caregiver’s insecurity about future difficulties, caregiver’s difficulty to perform his role and insecurity about patient’s future health. Caregiver’s burden was better predicted by lack of privacy (R .905), caregiver’s feeling that he will be unable to take care of the patient (R .882), caregiver’s effort to respond to family and work responsibilities additionally to patient’s care (R .839), and caregiver’s feeling of strain when he is close to the patient (R .77). Conclusions: This study underlies the importance of considering mental health needs of caregivers. The findings demonstrate that caregiving is associated not only with burden but also with erosion of mental health, a fact of which doctors should be aware. Given the general burden, caregivers are highly vulnerable to depression and other emotional disorders. Approaches either as family counseling or as support groups have to be widely developed in order to relieve the stress and burden experienced by caregivers of demented patients.