• Abnormal Face‐hand Testing is Associated with Anosognosia in Patients with Neuropathologically‐confirmed Alzheimer’s Disease

      Derksen, Brenna; The University of Arizona College of Medicine - Phoenix; Jacobson, Sandra (The University of Arizona., 2014-04)
      Objective To investigate whether specific elements of the neurological and neuropsychological evaluation are associated with anosognosia for memory impairment in subjects with neuropathologically-confirmed Alzheimer’s disease. Methods Included were subjects from the Arizona Study of Aging and Neurodegenerative Disease with clinically documented dementia and neuropathological confirmation of AD for whom anosognosia could be confirmed based on antemortem data. Anosognosia was defined by a discrepancy between 1) the patient’s self-report and results of testing, and/or 2) the patient’s self-report and the caregiver’s report regarding memory impairment. The anosognosic and non-anosognosic groups were compared on targeted clinical, cognitive, and neuropathological findings. Results Of 61 subjects included, 34 were diagnosed as anosognosic, and 27 non-anosognosic. The anosognosic group performed worse on two tests of frontal systems function - letter fluency (COWAT) (p=0.010) and a score derived from the Trailmaking test (Trailmaking B time – Trailmaking A time) (p=0.015). In addition, significantly more anosognosic subjects (92%) had abnormal results on face-hand testing (double simultaneous stimulation) compared to non-anosognosic subjects (62% abnormal; p=0.018). Significance In this study of patients with moderate Alzheimer’s disease (mean CDR=2), the anosognosic group showed significantly greater impairment on tests of frontal/executive function. In addition, this group had a significantly higher rate of abnormal face-hand testing, consistent with right parietal pathology. The FHT, which takes about 30 seconds to administer, may prove useful as a marker for anosognosia risk in AD.
    • Arizona Alzheimer’s Registry: Strategy and Outcomes

      Saunders, Kelley; The University of Arizona College of Medicine - Phoenix; Tariot, Pierre (The University of Arizona., 2014-04)
      Background: The Arizona Alzheimer’s Consortium (AAC) is a statewide Alzheimer’s disease (AD) research consortium. In 2006 the AAC created the Arizona Alzheimer’s Registry (Registry), a screening and referral process for people interested in participating in AD-related research. The Registry goals were to increase awareness of AD research and accelerate enrollment into AAC studies. Registrants were matched to AAC studies according to interest, location, and eligibility. Methods: Anyone age 18 and older was eligible. Registrants were recruited by community outreach, mass mailings, earned and paid media, and the Internet. Those interested received a welcome packet, consent, and questionnaire, which were reviewed by staff via telephone prior to brief cognitive screening. Evaluation of medical history, cognitive status, and interests resulted in a referral to existing AAC studies or being held for future referral. Results: 2263 people contacted the Registry. 1257 consented and 1182 underwent an initial cognitive screening. Earned media was the most effective recruitment strategy. Registrants had a mean age of 68.1 (SD 10.6), 97% were Caucasian, had 15.2 (SD 2.7) mean years of education, and 60% were female. 30% reported a family history of dementia, 20% reported a diagnosis of cognitive impairment or dementia, and 70% subjectively reported normal cognition. Initial telephone assessments revealed 681 with no impairment, 269 with possible cognitive impairment, and 234 with possible dementia. 301 were referred to AAC sites for potential enrollment into a study. Conclusion: The Registry created an infrastructure and process to screen and refer a high volume of eager Registrants. These methods were found to be effective at prescreening individuals for studies, which facilitated AAC research recruitment. The established infrastructure and experiences gained from the Registry have served as the prototype for the web-based Alzheimer’s Prevention Registry, a national registry focusing on AD prevention research.
    • Specific memory complaints and the identification of preclinical Alzheimer's disease years before conversion to Mild Cognitive Impairment.

      Adler, Claudia; The University of Arizona College of Medicine - Phoenix; Baxter, Leslie (The University of Arizona., 2014-04)
      Early detection of cognitive decline will become increasingly important as preventative therapies for Alzheimer’s disease (AD) become available. While new imaging techniques and biomarkers have shown evidence of neuropathology in the preclinical stages of AD, most clinicians must rely on the subjective report of symptoms to identify the onset of cognitive decline. Patients often present to primary care physicians with complaints from self or family members about confusion, memory loss or personality changes. However, discriminating complaints associated with normal from abnormal aging is difficult. The identification of patient-generated specific complaints indicating prodromal or Mild Cognitive Impairment (MCI) could lead to more prompt and effective intervention strategies for future dementia patients, and could improve prognosis. This study investigated how specific subjective complaints may be related to subsequent conversion to MCI in a cohort of cognitively normal elderly subjects who have a familial and/or genetic risk for AD. Subjects included cognitively intact participants and their informants (spouse, sibling, adult child) from a large longitudinal study of cognition in individuals with a family history of AD. Participants were further characterized by their APOE ε4 allele status. Both subjects and their informants were administered the Multidimensional Assessment of Neurodegenerative Symptoms (MANS), a questionnaire that assesses subjective changes in memory, personality, motor, vision, and speech. Of 85 subjects who were cognitively normal at the initial MANS administration, 12 converted to MCI within 25-167 months. The participants who later converted to MCI had greater memory complaints at baseline compared to nonconverters (2 = 5.65, p <0.05). There were no significant differences in other MANS domains. In regards to specific memory complaints, converters were significantly more likely to endorse symptoms of “losing or misplacing things” (2 = 13.99, p<0.001), having an “inability to keep events or tasks in right order,” (2 =12.06, p<0.001), "forgetting names of familiar people" (2 = 4.59, p < 0.05), and "forgetting things or events from long ago," (2 = 6.62, p < 0.05). Nonconverters also endorsed some memory complaints, but no complaint or group of complaints was endorsed more than others. The APOE ε4 allele was observed in 83% of the participants who converted to MCI compared to 52% of those who remained cognitively intact over the course of the assessment period. In cognitively normal subjects with a family history of AD, specific memory complaints about losing or misplacing items, forgetting the order of tasks or events, forgetting names of familiar people and forgetting things or events from long ago may be useful clinical tools for identifying Preclinical AD up to eight years before conversion to MCI.