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P2–212: Subjective cognitive impairment without dementia: Clinical and pathological outcomes in a community–based sample
Author(s) -
Wang Lucy Y.,
Vavrek Darcy A.,
Bowen James D.,
McCormick Wayne C.,
Teri Linda,
Montine Thomas J.,
Larson Eric B.,
Leverenz James B.,
Tsuang Debby W.
Publication year - 2006
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2006.05.1051
Subject(s) - dementia , wechsler adult intelligence scale , lewy body , psychology , neuropathology , dementia with lewy bodies , neuropsychology , pathological , progressive supranuclear palsy , memory impairment , alzheimer's disease , psychiatry , cognition , disease , pediatrics , medicine , clinical psychology
used in the diagnosis and staging of dementia (DEM) and mild cognitive impairment (MCI).The main emphasis of the CDR is DEM, rather than MCI. In the CDR, the history and the results of cognitive assessment are combined into a composite score for each domain, allowing variability between raters regarding the weights assigned to these components. Therefore, we created a modification of the CDR (the mCDR), which explores the earliest cognitive and non-cognitive symptoms of MCI, without any influence from objective cognitive assessments of the subject. Objective(s): To contrast the predictive utility of the mCDR versus the CDR in differentiating among normal (NOR), MCI and DEM subjects. Methods: A behavioral neurologist classified 46 individuals based on a detailed informant history as well as a clinical neurocognitive evaluation into the following groups: NOR (n 14, MMSE 27 2); MCI (n 16, MMSE 24 2), and DEM (n 16, MMSE 21 4). An independent rater derived the CDR global rating and box scores by reviewing a detailed written history and performance on the MMSE. A third rater scored the mCDR, by asking six standard questions for each of the six CDR domains (the most impaired symptom score in each domain was used as the index score). Using logistic regression analysis, CDR and mCDR subscores were compared in the ability to predict the clinician’s diagnostic classification of NOR, MCI or DEM. Results: Overall concordance with the “gold standard” clinical diagnostic classification was 83% for the CDR subscores but 95% for the mCDR subscores. Furthermore, concordance for the diagnosis of NOR versus MCI was 70% for the CDR, and 85% for the mCDR. Concordance for MCI versus DEM was 91% for CDR, and 94% for the mCDR. The non-memory domains of the mCDR accounted for most of its discriminative power. Conclusions: The mCDR appears superior to the CDR for separating NOR from MCI subjects, even though the mCDR does not include objective cognitive assessment. Thus, the mCDR may be a more useful tool than the CDR in future clinical diagnostic and research studies of MCI.