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Abstract
Background
O'Bryant et al. (2008) argued that the CDR Sum of Boxes (CDR-SB) can be used to distinguish MCI from very early dementia in patients with CDR-GS of 0.5. They reported that the optimal CDR-SB cut-off score was 2.5. The present study was conducted to examine whether the subgroups classified with CDR-SB scores showed the corresponding group differences on the cognitive tests.
Methods
The subjects were 45 amnestic multi-domain MCI (amMCI) and 53 vascular MCI (VaMCI) with CDR-GS of 0.5. Each patient group was classified into "mild (0.5-2.0)" and "severe (2.5-4.0)" subgroups based on the CDR-SB. As the result, 4 groups were formed such as mild amMCI (n=23), severe amMCI (n=22), mild VaMCI (n=29), and severe VaMCI (n=24). The subjects were given the MMSE, HDS-R, and MoCA. The MANCOVA was conducted separately for each test with a Bonferroni correction for multiple comparisons.
Results
Severe groups of both amMCI and VaMCI showed significantly lower performances than two mild groups in MMSE, HDS-R, and MoCA. It was found that "serial 100-7" was a good item to discriminate between the mild and severe groups in both amMCI and VaMCI. Items measuring "orientation" or "naming" showed significant subgroup differences in the amMCI, whereas items related to "memory," "visuospatial construction," or "frontal/executive function" showed significant subgroup differences in the VaMCI.
Conclusion
These results showed that there were significant differences in cognitive functions between the two subgroups with CDR-GS of 0.5. The results about the items discriminating between subgroups in amMCI and VaMCI were consistent with the previous findings about the progression of cognitive impairments in AD and VaD. Therefore, these results support the use of CDR-SB as a guideline for distinguishing MCI from early dementia.
Figures and Tables
Table 2
Group differences in the K-MMSE, K-HDS-R, & K-MoCA
*p<0.05, **p<0.01, ***p<0.001.
K-MMSE, Korean-Mini Mental State Examination; K-HDS-R, Korean version of Revised Hasegawa's Dementia Scale; K-MoCA, Korean-Montreal Cognitive Assessment; Mild amMCI, Mild amnestic Mild Cognitive Impairment; Mild VaMCI, Mild Vascular Mild Cognitive Impairment; Severe amMCI, Severe amnestic Mild Cognitive Impairment; Severe VaMCI, Severe Vascular Mild Cognitive Impairment.
References
1. Summers MJ, Saunders NLJ. Neuropsychological measures predict decline to Alzheimer's dementia from Mild Cognitive Impairment. Neuropsychology. 2012; 26:498–508.
2. Wilson RS, Leurgans SE, Boyle PA, Bennett DA. Cognitive decline in prodromal Alzheimer's disease and Mild Cognitive Impairment. Arch Neurol. 2011; 68:351–356.
3. Petersen RC. Mild Cognitive Impairment as a diagnostic entity. J Intern Med. 2004; 256:183–194.
4. Bowler JV, Steenhuis R, Hachinski V. Conceptual background to Vascular Cognitive Impairment. Alzheimer Dis Assoc Disord. 1999; 13:S30–S37.
5. Alexopoulos P, Grimmer T, Perneczky R, Domes G, Kurz A. Progression to dementia in clinical subtypes of Mild Cognitive Impairment. Dement Geriatr Cogn Disord. 2006; 22:27–34.
6. Gorelick PB, Scuteri A, Black SE, DeCarli C, Greenberg SM, Iadecola C, et al. Vascular contributions to cognitive impairment and dementia: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011; 42:2672–2713.
7. O'Bryant SE, Waring SC, Cullum M, Hall J, Lacritz LH, Massman PJ, et al. Staging dementia using Clinical Dementia Rating scale Sum of Boxes scores. Arch Neurol. 2008; 65:1091–1094.
8. Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry. 1982; 140:566–572.
9. O'Bryant SE, Lacritz LH, Hall J, Waring SC, Chan W, Khodr ZG, et al. Validation of the new interpretive guidelines for the Clinical Dementia Rating scale Sum of Boxes score in the National Alzheimer's Coordinating Center database. Arch Neurol. 2010; 67:746–749.
10. Choi SH, Lee BH, Kim S, Hanm DS, Jeong JH, Yoon SJ, et al. Interchanging scores between Clinical Dementia Rating scale and Global Deterioration Scale. Alzheimer Dis Assoc Disord. 2003; 17:98–105.
11. Kang Y, Jahng SM, Na DL. Seoul Neuropsychological Screening Battery. 2nd Edition. Seoul: Human Brain Research & Consulting;2012.
12. Kang Y. A normative study of the Korean-Mini Mental State Examination (K-MMSE) in the elderly. Korean J Psychol. 2006; 25:1–12.
13. Yang DW, Kim BS, Shim DS, Chung SW, Lee KS, Han SH, et al. Reliability and validity of the Korean version of revised form of Hasegawa Dementia Scale (K-HDS). J Korean Neurol Assoc. 2004; 22:315–321.
14. Kang Y, Park J, Yu KH, Lee BC. A reliability, validity, and normative study of the Korean-Montreal Cognitive Assessment (K-MoCA) as an instrument for screening of Vascular Cognitive Impairment (VCI). Korean J Clin Psychol. 2009; 28:549–562.
15. Folstein Mf, Folstein SE, McHugh PR. "MINI-MENTAL STATE": A Practical method for granding the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12:189–198.
16. Imai Y, Hasegawa K. The revised Hasegawa's Dementia Scale (HDS-R)-evaluation of its usefulness as a screening test for dementia. J Hong Kong Coll Psychiatr. 1994; 4:20–24.
17. Nasreddine ZS, Phillips NA, Bediria V, Charbonneau S, Whitehead V, Collin I. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53:695–699.
18. Peterson RC. Mild Cognitive Impairment or questionable dementia? Arch Neurol. 2000; 57:643–644.
19. Domoto-Reilly K, Sapolsky D, Brickhouse M, Dickerson BC. Naming impairment in Alzheimer's disease is associated with left anterior temporal lobe atrophy. Neuroimage. 2012; 63:348–355.
20. O'Brien JT, Erkinjuntti T, Reisberg B, Roman G, Sawada T, Pantoni L, et al. Vascular cognitive impairment. Lancet Neurol. 2003; 2:89–98.
21. Moorhouse P, Rockwood K. Vascular cognitive impairment: Current concepts and clinical developments. Lancet Neurol. 2008; 7:246–255.
22. Morris JC, Storandt M, Miller JP, McKeel DW, Price JL, Rubin EH, et al. Mild cognitive impairment represents early-stage Alzheimer's disease. Arch Neurol. 2001; 58:397–405.
23. Wentzel C, Rockwood K, MacKnight C, Hachiski V, Hogan DB, Feldman H, et al. Progression of impairment in patients with vascular cognitive impairment without dementia. Neurology. 2001; 57:714–716.
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