Kristiina Hongisto

Progression of Alzheimer's disease during a three-year follow-up using the CERAD-NB total score: Kuopio ALSOVA study

BACKGROUND We studied the suitability of The Consortium to Establish a Registry for Alzheimers Disease Neuropsychological Battery (CERAD-NB) total score for monitoring Alzheimers disease (AD) progression in early-diagnosed medicated patients. We also investigated possible differences in progression between patients with very mild or mild baseline AD. METHODS In this three-year follow-up of 115 ALSOVA study patients with clinical dementia ratings (CDR) of very mild (0.5) or mild (1) AD, we analyzed total CERAD-NB, Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), The Alzheimers Disease Cooperative Study-Activities of Daily Living Inventory, and Clinical Dementia Rating Sum of Boxes scores. Correlations were identified with efficacy parameters. RESULTS Over three years, total CERAD-NB declined significantly in both groups. Annual change rates of total CERAD-NB were also significant. Total CERAD-NB revealed annual differences in cognition between study groups, while MMSE did not. Total CERAD-NB correlated well with other cognitive and global measures, but not with NPI. For almost two years, the CDR-0.5 group maintained a higher activities of daily living than the CDR-1 group exhibited at baseline. Furthermore, the CDR-0.5 group showed milder neuropsychiatric symptoms at the end of follow-up than the CDR-1 group showed at baseline. CONCLUSIONS The CERAD total score is a suitable and sensitive follow-up tool in longitudinal AD trials. Cognition progression rates did not significantly differ between study groups; however, patients with very mild AD at baseline had milder neuropsychiatric symptoms after long-term follow-up. This emphasizes the importance of early diagnosis and assessment of neuropsychiatric symptoms at the diagnostic visit and during follow-up.

Physical Activity and Alzheimer’s Disease: A Systematic Review

The current literature includes several studies investigating the association between physical activity and risk of Alzheimers disease (AD). The aim of this review was to systematically evaluate available evidence on this association. Medline via PubMed and CINAHL databases were searched for original English language research articles assessing the relationship between physical activity and incident AD. The review was limited to prospective observational and intervention studies. Criteria for exclusion were studies focusing on individuals with dementia, cross-sectional study design, and case reports. The quality of included studies was assessed in 5 domains of bias. Twenty-four studies met the inclusion criteria. The number of participants ranged from 176 to 5,698. Follow-up time varied from 1 to 34 years. Physical activity was inversely associated with risk of AD in most studies (n = 18). Leisure-time physical activity was particularly protective against AD, but not work-related physical activity. The risk of bias assessment showed that overall quality of evidence was moderate for 16 and low for 8 studies. Beyond all the available general recommendations for health promotion, current evidence does not allow to draw specific practical recommendations concerning the types, frequency, intensity, or duration of physical activity that may be protective against AD.

Early psychosocial intervention does not delay institutionalization in persons with mild Alzheimer disease and has impact on neither disease progression nor caregivers' well-being: ALSOVA 3-year follow-up.

Early diagnosis, initiation of Alzheimers disease (AD) therapy and programs that support care of persons with AD at home are recommended. The objective of this study was to assess the effect of early psychosocial intervention on delaying the institutionalization of persons with AD. We also assessed the influence of intervention on AD progression, behavioral symptoms, and health‐related quality of life (HRQoL) in persons with AD and caregivers.

Quality of Life in relation to neuropsychiatric symptoms in Alzheimer's disease: 5‐year prospective ALSOVA cohort study

To examine the association between neuropsychiatric symptoms (NPS) with self‐ and caregiver‐rated Quality of Life (QoL) for patients with Alzheimers disease (AD) during a 5‐year follow‐up.

The Progression of Alzheimer's Disease Can Be Assessed with a Short Version of the CERAD Neuropsychological Battery: The Kuopio ALSOVA Study

Background/Aims: Measuring and predicting Alzheimers disease (AD) progression is important in order to adjust treatment and allocate care resources. We aimed to identify a combination of subtests from the Consortium to Establish a Registry for Alzheimers Disease Neuropsychological Battery (CERAD-NB) that best correlated with AD progression in follow-up as well as to predict AD progression. Method: A total of 236 participants with very mild [Clinical Dementia Rating (CDR) = 0.5] or mild AD (CDR = 1.0) at baseline were followed up for 3 years. The CERAD-NB and Mini-Mental State Examination (MMSE) were used to assess cognition, and the CDR scale sum of boxes (CDR-sb) was employed to evaluate AD progression. Generalized estimating equations were used to develop models to predict and follow up disease progression. Results: Performance declined on all CERAD-NB subtests. The ability of the separate subtests to distinguish between groups (baseline CDR = 0.5 or 1.0) diminished during follow-up. The best combination of subtests that explained 62% of CDR-sb variance in follow-up included verbal fluency, constructional praxis, the clock drawing test, and the MMSE. Baseline values of the same combination predicted 37% of the CDR-sb change. Conclusion: A short version of the CERAD-NB subtests provides a promising and time-efficient alternative for measuring cognitive deterioration during AD follow-up. Although the initial signs of AD include memory difficulties, it may be useful to assess non-memory tasks in follow-up.

Neuropsychatric Sympions and Quality of Life in Patients with very mild and mild aizheimer's disease

OF LIFE IN PATIENTS WITH VERY MILD AND MILD AIZHEIMER’S DISEASE Anne Koivisto, Kristiina Hongisto (former Karttunen), Hilkka Soininen, Pertti Karppi, Asta Hiltunen, Tarja V€alim€aki, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland; 3 Mikkeli Central Hospital, Mikkeli, Finland; Department of Neurology, North Carelia Central Hospital, Joensuu, Finland.