Kasper Jørgensen

Performances on five verbal fluency tests in a healthy, elderly Danish sample

ABSTRACT Verbal fluency tests are widely used as measures of language and executive functions. This study presents data for five tests; semantic fluency (animals, supermarket items and alternating between cities and professions), lexical fluency (s-words), and action fluency (verbs) based on a sample of 100 cognitively intact elderly Danish subjects aged 60–87 years. We found mean scores similar to what has been reported from other countries. There was little influence of background variables: in four out of fives tests less than 20% of the variance could be explained by age, education, and estimated intelligence. Age had a greater impact than education on category based performance, while the opposite was the case for lexical- and action-based fluency. Overall, intelligence was of little importance. There was a positive and significant correlation between all tests, but with only low to moderate strength of association, indicating that various fluency tasks draw on different cognitive abilities and are not interchangeable.

Visuoconstructional abilities in cognitively healthy illiterate Turkish immigrants: a quantitative and qualitative investigation.

Assessment of visuospatial function is an integral part of most neuropsychological assessments and is frequently assessed by visuoconstructional tests. A significant impact of limited schooling and illiteracy has been found on numerous neuropsychological tests and it can be difficult to interpret test results from illiterate individuals. In this study, quantitative and qualitative aspects of performance of elderly cognitively healthy illiterate and literate Turkish immigrants were compared on five commonly used visuoconstructional tests. Significantly poorer performances of illiterate compared to literate subjects were found in copying of two- and three-dimensional geometric designs, and in Clock Drawing Test performance. A systematic qualitative analysis found lacking three-dimensionality, “curved angles”, omissions, distorted relation between elements, and spatial disorganization to be common error types in illiterate subjects. Performances were not found to be influenced by duration of residence in Denmark or level of acculturation. The results warrant caution in the interpretation of visuoconstructional test performances in illiterate subjects, as they can easily be misinterpreted as signs of cognitive dysfunction.

Performances on Symbol Digit Modalities Test, Color Trails Test, and modified Stroop test in a healthy, elderly Danish sample

ABSTRACT This study presents Danish data for the Symbol Digit Modalities Test (SDMT), Color Trails Test (CTT), and a modified Stroop test from 100 subjects aged 60–87 years. Among the included demographic variables, age had the highest impact on test performances. Thus, the study presents separate data for different age groups. For SDMT and CTT1, Danish Adult Reading Test (DART) score also had a significant impact on test performances. The incongruent version of the modified Stroop test was significantly correlated to education. Moderate and significant correlations were found between the three tests. Even though the three tests are commonly used, few normative data for elderly exists. SDMT and CTT performances from this study were in the same range as previously published international norms, but the validity of the result from the modified Stroop test could not be investigated.

Development of a dementia assessment quality database

Objective: Increased focus on the quality of health care requires tools and information to address and improve quality. One tool to evaluate and report the quality of clinical health services is quality indicators based on a clinical database. Method: The Capital Region of Denmark runs a quality database for dementia evaluation in the secondary health system. One volume and seven process quality indicators on dementia evaluations are monitored. Indicators include frequency of demented patients, percentage of patients evaluated within three months, whether the work-up included blood tests, Mini Mental State Examination (MMSE), brain scan and activities of daily living and percentage of patients treated with anti-dementia drugs. Indicators can be followed over time in an individual clinic. Up to 20 variables are entered to calculate the indicators and to provide risk factor variables for the data analyses. Results: The database was constructed in 2005 and covers 30% of the Danish population. Data from all consecutive cases evaluated for dementia in the secondary health system in the Capital Region of Denmark are entered. The database has shown that the basic diagnostic work-up programme with MMSE, and a brain scan is performed in almost all patients. Differences in the prevalence of etiological diagnoses indicate differences in the application of the diagnostic criteria. This has initiated a process to harmonize the use of diagnostic criteria and the MMSE including administration guide. Conclusion: Clinical quality indicators based on all patients evaluated for dementia can be used to standardize and harmonize the evaluation process and improve clinical health services.

Frequency and Severity of Semantic Deficits in a Consecutive Memory Clinic Cohort

Background/Aim: Semantic memory deficits have been shown in dementia and mild cognitive impairment (MCI) by group comparisons. The aim of this study is to investigate the frequency of impairments on tests with semantic content in patients with dementia, MCI (amnestic and non-amnestic) and affective disorders. Methods: A Famous faces test, Boston Naming Test and Category fluency were applied in 114 consecutive memory clinic patients and 95 healthy participants (all participants were 60 years old or older; dementia/MCI patients had Mini-Mental State Examination scores ≥20). Results: Fifty-three patients were classified with dementia, 36 with MCI (14 amnestic, 22 non-amnestic) and 25 with affective disorders. Dementia and MCI patients differed significantly from the control group on all tests. Patients with dementia and MCI had impairments in about 40% of the cases (on the most sensitive tests). However, patients with affective disorders also had mild impairments on tests tapping semantic memory (25% were impaired on the most sensitive tests). Impairments on the Famous faces test were more frequently found in dementia and MCI as compared to patients with affective disorders. Conclusion: Short tests with semantic memory content are sensitive to changes in dementia and MCI, but impairments on such tests may also be found in other diseases, e.g. affective disorders.

The six-item Clock Drawing Test – reliability and validity in mild Alzheimer’s disease

This study presents a reliable, short and practical version of the Clock Drawing Test (CDT) for clinical use and examines its diagnostic accuracy in mild Alzheimer’s disease versus elderly nonpatients. Clock drawings from 231 participants were scored independently by four clinical neuropsychologists blind to diagnostic classification. The interrater agreement of individual scoring criteria was analyzed and items with poor or moderate reliability were excluded. The classification accuracy of the resulting scoring system – the six-item CDT – was examined. We explored the effect of further reducing the number of scoring items on classification accuracy and estimated classification accuracy associated with performances deviating from the optimal cutoff score. At a cutoff of 5/6, the six-item CDT had a sensitivity (SN) of 0.65 and a specificity of 0.80. Stepwise removal of up to three items reduced SN slightly. Classification accuracy associated with a score of four or less out of six was very high.

Negative content of thinking in panic disorder and major depression–a self‐report study

The purpose of the present study was to investigate the character and extent of negative thought content in panic disorder (PD) and the relation between thinking and bodily sensations. Content of thinking was explored in several areas, some of which are not exclusively related to anxiety. A structured diagnostic interview (SCID), a self-rating scale (SCL-90R), a sentence construction test (The Incomplete Sentences Blank (ISB)), and an inventory of childhood memories of parental rearing (the EMBU) were administered to 47 PD patients, 15 patients with major depression (MD), and 30 normal subjects. Thus, measures of implicit as well as explicit thinking, measures of thinking on present as well as past issues, and methods allowing negative as well as positive thought content to be expressed, were used. We found that PD was characterized by more negative thinking of anxiogenic, depressive, and dependent nature and less neutral or positive thinking than the normal subjects, primarily in issues related to the present. These negative thoughts were correlated with bodily symptoms. Very few significant differences were found between PD and MD, but a subgroup of PD with comorbidity of MD exceeded the other groups on measures of negative thoughts as well as bodily symptoms.

Psychometric properties and reference data for Danish versions of Free and Cued Selective Reminding Test, Category Cued Memory Test and Logical Memory

Memory assessment is a key element in neuropsychological testing. Gold standard evaluation is based on updated normative data, but in many small countries (e.g. in Scandinavia) such data are sparse. In Denmark, reference data exist for non-verbal memory tests and list-learning tests but there is no normative data for memory tests which capture narrative recall and cued recall. In a nation-wide study, Free and Cued Selective Reminding Test (FCSRT), WMS-III Logical Memory (LM) and a newly developed test Category Cued Memory Test (CCMT-48) were applied in 131 cognitively intact persons (aged 60-96 years). Regression-based reference data for Danish versions of FCSRT, CCMT-48 and LM adjusted for age, education and gender are provided. Gender and age-group had a significant impact on the expected scores, whereas the effect of education had a limited effect on expected scores. Test performances were significantly correlated in the range 0.21-0.51. Based on these findings and previous results it may be relevant to assess both free recall, cued recall and recognition to tap the earliest changes associated with neurodegeneration, and this study therefore provides an important supplement to existing Danish normative data. Future studies should investigate the discriminative validity of the tests and the clinical utility of the presented reference data.

COST OF ILLNESS ESTIMATES FOR DEMENTIA IN DENMARK: A REVIEW

disease progression was modeled using equations derived directly from trial data. Changes in antipsychotic medications use upon initiation of AD treatment and following treatment discontinuation were incorporated using data from a published retrospective cohort study. Costs included drug acquisition and monitoring costs, total medical costs and informal care costs associated with caregiver time. Costs were reported in 2013 US dollars. Costs and health outcomes were discounted at 3% per annum. Results: Over 3 years, combination therapy was less costly and more effective when compared with AChEI monotherapy. Combination therapy was associated with a discounted quality-adjusted life-year (QALY) gain of 0.13 per patient. Over 3 years, direct medical and societal discounted costs were reduced by

Clinical database indicators improves dementia evaluations in the secondary health service

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