Popular cognitive test for Alzheimer’s insufficiently sensitive

January, 2013

The most common cognitive test used in clinical trials for Alzheimer’s treatments has been shown to have significant flaws that underestimate cognitive change.

New research suggests that reliance on the standard test Alzheimer's Disease Assessment Scale—Cognitive Behavior Section (ADAS-Cog) to measure cognitive changes in Alzheimer’s patients is a bad idea. The test is the most widely used measure of cognitive performance in clinical trials.

Using a sophisticated method of analysis ("Rasch analysis"), analysis of ADAS-Cog data from the AD Neuroimaging Initiative (675 measurements from people with mild Alzheimer's disease, across four time points over two years) revealed that although final patient score seemed reasonable, at the component level, a ceiling effect was revealed for eight out of the 11 parts of the ADAS-Cog for many patients (32-83%).

Additionally, for six components (commands, constructional praxis, naming objects and fingers, ideational praxis, remembering test instructions, spoken language), the thresholds (points of transition between response categories) were not ordered sequentially. The upshot of this is that, for these components, a higher score did not in fact confirm more cognitive impairment.

The ADAS-Cog has 11 component parts including memory tests, language skills, naming objects and responding to commands. Patients get a score for each section resulting in a single overall figure; different sections have different score ranges. A low total score signals better cognitive performance; total score range is 0-70, with 70 being the worst.

It seems clear from this that the test seriously underestimates cognitive differences between people and changes over time. Given that this is the most common cognitive test used in clinical trials, we have to consider whether these flaws account for the failure of so many drug trials to find significant benefits.

Among the recommended ways to improve the ADAS-Cognitive (including the need to clearly define what is meant by cognitive performance!), the researchers suggest that a number of the components should be made more difficult, and that the scoring function of those six components needs to be investigated.

Reference: 

Related News

In the past few months, several studies have come out showing the value of three different tests of people's sense of smell for improving the accuracy of

A study comparing the language abilities of 22 healthy young individuals, 24 healthy older individuals and 22 people with

Following on from a previous study showing that such a virtual supermarket game administered by a trained professional can detect

Data from the Women's Health Initiative Memory Study, involving 6,467 postmenopausal women (65+) who reported some level of caffeine consumption, has found that those who consumed above average amounts of coffee had a lower risk of developing dementia.

Our bodies’ ability to regulate its temperature gets worse with age, along with a slowing metabolism. We also become more vulnerable to Alzheimer's as we age. A study compared mice genetically engineered to manifest Alzheimer's symptoms as they age with normal mice.

People with Alzheimer's disease develop problems in recognizing familiar faces. It has been thought that this is just part of their general impairment, but a new study indicates that a specific, face-related impairment develops early in the disease.

Data from 876 patients (average age 78) in the 30-year Cardiovascular Health Study show that virtually any type of aerobic physical activity can improve brain volume and reduce Alzheimer's risk.

A study involving 100 older adults (aged 80-99) with hearing loss has found that those who used a hearing aid performed significantly better on a cognitive test (MMSE) than those who didn't use a hearing aid, despite having poorer hearing.

A study involving 65 older adults (average age 66), of whom 35 had type 2 diabetes, has found that after two years, those with diabetes had decreases in their ability to regulate blood flow in the brain, and a reduced ability to regulate blood flow was associated with lower cognitive scores.

A small study that fitted 29 young adults (18-31) and 31 older adults (55-82) with a device that recorded steps taken and the vigor and speed with which they were made, has found that those older adults with a higher step rate performed better on memory tasks than those who were more sedentary.

Pages

Subscribe to Latest newsSubscribe to Latest newsSubscribe to Latest health newsSubscribe to Latest news