Gerda G. Fillenbaum

The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assesment of Alzheimer's disease

The Consortium to Establish a Registry for Alzheimers Disease (CERAD) has developed brief, comprehensive, and reliable batteries of clinical and neuropsychological tests for assessment of patients with the clinical diagnosis of Alzheimers disease (AD). We administered these batteries in a standardized manner to more than 350 subjects with a diagnosis of AD and 275 control subjects who were enrolled in a nationwide registry by a consortium of 16 university medical centers. The tests selected for this study measured the primary cognitive manifestations of AD across a range of severity of the disorder, and discriminated between normal subjects and those with mild and moderate dementia. The batteries also detected deterioration of language, memory, praxis, and general intellectual status in subjects returning for reassessment 1 year later. Interrater and testretest reliabilities were substantial. Long-term observations of this cohort are in progress in an effort to validate the clinical and neuropsychological assessments and to confirm the diagnosis by postmortem examinations. Although information on validation is limited thus far, the CERAD batteries appear to fill a need for a standardized, easily administered, and reliable instrument for evaluating persons with AD in multicenter research studies as well as in clinical practice.

The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part V. A normative study of the neuropsychological battery

The neuropsychological tests developed for the Consortium to Establish a Registry for Alzheimers Disease (CERAD) are currently used to measure cognitive impairments of Alzheimers disease (AD) in clinical investigations of this disorder. This report presents the normative information for the CERAD battery, obtained in a large sample (n = 413) of control subjects (ages 50 to 89) who were enrolled in 23 university medical centers in the United States participating in the CERAD study from 1987 to 1992. We compared separately the performance of subjects with high (≥12) and low (<12) years of formal education. For many of the individual cognitive measures in the highly educated group, we observed significant age and gender effects. Only the praxis measure showed a significant age effect in the low-education group. Delayed recall, when adjusted for amount of material acquired (savings), was relatively unaffected by age, gender, and level of education. Our findings suggest that the savings scores, in particular, may be useful in distinguishing between AD and normal aging.

Educational status and active life expectancy among older blacks and whites.

BACKGROUND AND METHODS Persons of low socioeconomic status are known to have reduced life expectancy. In a study of the relation of socioeconomic status to disability-free or active life expectancy among older persons, we analyzed prospectively gathered data on 2219 blacks and 1838 whites who were 65 years of age or older in the Piedmont region of North Carolina. We defined disability as the inability to perform independently one or more basic functional activities such as walking, bathing, dressing, eating, and using the toilet. For subgroups defined by sex, race, and education, statistical models were used to estimate, for persons at each year of age, the probability of transition from not being disabled or being disabled at base line to not being disabled, being disabled, or having died one year later. These transition probabilities were then entered into increment-decrement life tables to generate estimates of total, active, and disabled life expectancy (with total life expectancy equal to active life expectancy plus disabled life expectancy). RESULTS Sixty-five-year-old black men had a lower total life expectancy (11.4 years) and active life expectancy (10 years) than white men (total life expectancy, 12.6 years; active life expectancy, 11.2 years), although the differences were reduced after we controlled for education. The estimates for 65-year-old black women (total life expectancy, 18.7 years; active life expectancy, 15.9 years) were similar to those for white women. Black men and women 75 years old and older had higher values for total life expectancy and active life expectancy than whites, and the differences were larger after stratification for education. Education had a substantially stronger relation to total life expectancy and active life expectancy than did race. At the age of 65, those with 12 or more years of education had an active life expectancy that was 2.4 to 3.9 years longer than the values for those with less education in all the four subgroups defined by sex and race. Overall, the subgroups with longer total life expectancy and active life expectancy also lived more years with a disability. CONCLUSIONS Among older blacks and whites, the level of education, a measure of socioeconomic status, has a greater effect than race on total life expectancy and active life expectancy.

The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Part IV. Rates of cognitive change in the longitudinal assessment of probable Alzheimer's disease

Reliable information on rate of progression of cognitive impairment in probable Alzheimers disease (AD) is important for evaluating possible beneficial effects of therapeutic agents and in planning long-term care for patients with this chronic illness. However, wide variability exists in published rates of change for psychometric measures of the dementing process, and there is need for an accurate analysis of large numbers of persons with the disorder studied over long periods. Utilizing the large, well-characterized sample of the Consortium to Establish a Registry for Alzheimers Disease and employing a least squares regression method to adjust for different levels of impairment and periods of observation, we report rates of change on the Short Blessed Test, Mini-Mental State Examination, Blessed Dementia Scale, Clinical Dementia Rating, and other cognitive measures in 430 patients with probable AD (mean age at entry = 70.9 ± 8.0 SD years) studied for up to 4 years. We found that rate-of-change determinations are less reliable when the observation period is 1 year or less, that dementia progression may be nonlinear when described by certain measures, and that simple change scores do not accurately characterize the rate of decline. We also found that rate of progression in AD is determined by the severity of cognitive impairment: the less severe the dementia, the slower the rate of decline.

Nutrition and Function: Is There a Relationship Between Body Mass Index and the Functional Capabilities of Community-Dwelling Elderly?

Objective: To determine if there is a relationship between body mass index and the ability to perform the usual activities of living in a sample of community‐dwelling elderly.

Identifying frailty in hospitalized older adults with significant coronary artery disease

OBJECTIVES: To characterize physiological variation in hospitalized older adults with severe coronary artery disease (CAD) and evaluate the prevalence of frailty in this sample, to determine whether single‐item performance measures are good indicators of multidimensional frailty, and to estimate the association between frailty and 6‐month mortality.

Risk due to inactivity in physically capable older adults.

OBJECTIVES This study examined the association between recreational physical activity among physically capable older adults and functional status, incidence of selected chronic conditions, and mortality over 3 and 6 years. METHODS Data are from three sites of the Established Populations for Epidemiologic Studies of the Elderly. RESULTS A high level of recreational physical activity reduced the likelihood of mortality over both 3 and 6 years. Moderate to high activity reduced the risk of physical impairments over 3 years; this effect diminishes after 6 years. A consistent relationship between activity and new myocardial infarction or stroke or the incidence of diabetes or angina was not found after 3 or 6 years. CONCLUSIONS Findings suggest that physical activity offers benefits to physically capable older adults, primarily in reducing the risk of functional decline and mortality. Future work must use more objective and quantifiable measures of activity and assess changes in activity levels over time.

Sensitivity and specificity of standardized screens of cognitive impairment and dementia among elderly black and white community residents

Six standardized published measures of cognitive function were evaluated as screens of dementia in a sample of 164 (83 black, 81 white) community residents aged 65 and over selected from the Duke University EPESE (Established Populations for Epidemiologic Studies of the Elderly), a biracial cohort of 4164 residents in a five county area of piedmont North Carolina. Of these 164 persons, 26 were subsequently diagnosed as demented. The weighted data from this sample represent the estimated performance of these measures among elderly blacks and whites in a five county area. The 6 measures evaluated in this study (specificity figures for blacks precede those for whites) were (1) Orientation-Memory-Concentration Test (38%, 79%), (2) Mental Status Questionnaire (71%, 96%), (3) Mini-Mental State (58%, 94%), (4) Storandt et al. Battery (42%, 69%), (5) Iowa Battery (26%, 69%) and (6) Kendrick Cognitive Tests (92%, 97%). All but the Kendrick Cognitive Tests showed substantial sensitivity (90-100%) in detecting the presence of dementia. The specificity of the tests was particularly poor for blacks. The briefer, simpler measures tended to have greater accuracy than the longer and more complex measures. With rare exceptions, the scores obtained on these screens correlated with race and education.

Social context and self-assessments of health among the elderly.

Self-assessments of health made by randomly selected mentally capable older persons in the community (N = 937) and in institutions (N = 61) were compared with objective measures of their health (number of problems, different medicines used, number of diagnosed illnesses). Self-assessment was found to be related to these objective health measures among community residents but not among those in institutions. Among community residents, but not among those in institutions, there were also sex-related differences, women having a poorer objectively assessed health status for a given self-assessment of health than men. These findings extend those of others which indicate that health self-assessments reflect actual health status (and so are useful in surveys), by showing that the accuracy of the information obtained can be enhanced when the sex of the respondent is taken into account.

Relationship of health and demographic characteristics to Mini-Mental State Examination score among community residents

Mini-Mental State findings from an age 60+ random community sample (N = 1681) indicate that score is related to education, age and race (but not sex) and to functional status, but not to selected aspects of physical or mental health. Adjustment for demographic characteristics, particularly education, is recommended lest cognitive impairment be overestimated.