Overcoming barriers in cognitive assessment of Alzheimer's disease

Parra, Mario Alfredo

doi:10.1590/S1980-57642014DN82000002

ABSTRACT

Diagnosis of Alzheimer's disease (AD) requires a reliable neuropsychological assessment, but major barriers are still encountered when such tests are used across cultures and during the lifespan. This is particularly problematic in developing countries where most of the available assessment tools have been adapted from developed countries. This represents a major limitation as these tests, although properly translated, may not embody the wealth of challenges that a particular culture poses on cognition. This paper centers on two shortcomings of available cognitive tests for AD, namely, their sensitivity to the educational background and to the age of the individual assessed.

Key words:
Alzheimer's disease; neuropsychological evaluation; cognitive assessment; diagnosis

RESUMO

O diagnóstico da doença de Alzheimer (DA) necessita de uma avaliação neuropsicológica de confiança, barreiras importantes ainda são encontradas quando esses testes são usados em através de culturas e durante a vida. Isto é particularmente problemático em países em desenvolvimento, onde a maioria das ferramentas de avaliação disponíveis foram adaptadas a partir de países desenvolvidos. Isto representa uma grande limitação, pois mesmo devidamente traduzidas, podem não pode capturar a riqueza de desafios que uma determinada cultura representa na cognição. Neste artigo vou me concentrar em duas falhas de testes cognitivos disponíveis para AD, sensibilidade ao nível educacional e idade do indivíduo avaliado.

Palavras-chave:
doença de Alzheimer; avaliação neuropsicológica; avaliação cognitiva; diagnóstico

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Full text available only in PDF format.

REFERENCES

¹
Fields JA, Ferman TJ, Boeve BF, Smith GE. Neuropsychological assessment of patients with dementing illness. Nat Rev Neurol 2011;7:677-687.
²
Weintraub S, Wicklund AH, Salmon DP. The neuropsychological profile of Alzheimer disease. Cold Spring Harb Perspect Med 2012;2:a006171.
³
Jacova C, Kertesz A, Blair M, Fisk JD, Feldman HH. Neuropsychological testing and assessment for dementia. Alzheimers Dement 2007; 3:299-317.
⁴
Nielsen TR, Waldemar G. Dementia in ethnic minorities. Ugeskr Laeger 2010;172:1527-1531.
⁵
Ardila A, Roselli M, Puente A. Neuropsychological evaluation of the Spanish speaker. Critical Issues in Neuropsychology. New York: Plenum Press; 1994.
⁶
Rosselli M, Ardila A. The impact of culture and education on non-verbal neuropsychological measurements: a critical review. Brain Cogn 2003;52:326-333.
⁷
Rosselli M, Ardila A. Effects of age, education, and gender on the Rey-osterrieth complex figure. Clin Neuropsychol 1991;5:370-376.
⁸
Ardila A, Rosselli M, Rosas P. Neuropsychological assessment in illiterates: visuospatial and memory abilities. Brain Cogn 1989;11:147-166.
⁹
Becker RE, Greig NH, Giacobini E. Why do so many drugs for Alzheimer's disease fail in development? Time for new methods and new practices? J Alzheimers Dis 2008;15:303-325.
¹⁰
Parra MA. Cognitive assessment in Alzheimer's disease. Adv Alzheimer's Dis 2013;2:123-125.
¹¹
Alzheimer's Disease International. World Alzheimer Report: Executive Summary. 2009:12.
¹²
Parra MA, Sala SD, Abrahams S, Logie RH, Mendez LG, Lopera F. Specific deficit of colour-colour short-term memory binding in sporadic and familial Alzheimer's disease. Neuropsychologia 2011;49:1943-1952.
¹³
Lopera F, Ardilla A, Martinez A, et al. Clinical features of early-onset Alzheimer disease in a large kindred with an E280A presenilin-1 mutation. JAMA 1997;277:793-799.
¹⁴
Brickman AM, Paul RH, Cohen RA, et al. Category and letter verbal fluency across the adult lifespan: relationship to EEG theta power. Arch Clin Neuropsychol 2005;20:561-573.
¹⁵
Mack WJ, Teng E, Zheng L, Paz S, Chui H, Varma R. Category fluency in a latino sample: associations with age, education, gender, and language. J Clin Exp Neuropsychol 2005;27:591-598.
¹⁶
Rosselli M, Ardila A, Salvatierra J, Marquez M, Matos L, Weekes VA. A cross-linguistic comparison of verbal fluency tests. Int J Neurosci 2002;112:759-776.
¹⁷
Henry JD, Crawford JR, Phillips LH. Verbal fluency performance in dementia of the Alzheimer's type: a meta-analysis. Neuropsychologia 2004;42:1212-1222.
¹⁸
Parra MA, Della Sala S, Logie RH, Morcom AM. Neural correlates of shape-color binding in visual working memory. Neuropsychologia 2014; 52:27-36.
¹⁹
Parra MA, Abrahams S, Logie RH, Mendez LG, Lopera F, Della Sala S. Visual short-term memory binding deficits in familial Alzheimer's disease. Brain 2010;133:2702-2713.
²⁰
Parra MA, Abrahams S, Fabi K, Logie R, Luzzi S, Della Sala S. Short-term memory binding deficits in Alzheimer's disease. Brain 2009;132: 1057-1066.
²¹
Logie R, Brockmole JR, Vandenbroucke ARE. Bound Feature Combinations in Visual Short Term Memory are Fragile but Influence Long-Term Learning. Vis Cog 2009;17:160-179.
²²
Brockmole JR, Logie RH. Age-Related Change in Visual Working Memory: A study of 55,753 Participants Aged 8 to 75. Front Psychol 2013;4.
²³
Brockmole JR, Parra MA, Della Sala S, Logie R. Do Binding Deficits Account for Age-Related Decline in Visual Working Memory? Psychol Bull Rev 2008;15:543-547.
²⁴
Old SR, Naveh-Benjamin M. Differential effects of age on item and associative measures of memory: a meta-analysis. Psychol Aging 2008; 23:104-118.
²⁵
Deary IJ, Johnson W, Starr JM. Are processing speed tasks biomarkers of cognitive aging? Psychol Aging 2010;25:219-228.
²⁶
Bondi MW, Houston WS, Salmon DP, et al. Neuropsychological deficits associated with Alzheimer's disease in the very-old: discrepancies in raw vs. standardized scores. J Int Neuropsychol Soc 2003;9:783-795.
²⁷
Sperling RA, Karlawish J, Johnson KA. Preclinical Alzheimer disease [mdash] the challenges ahead. Nat Rev Neurol 2013;9:54-58.
²⁸
Mitchell KJ, Raye CL, Johnson MK, Greene EJ. An fMRI investigation of short-term source memory in young and older adults. Neuroimage 2006;30:627-633.
²⁹
Parra MA, Fabi K, Luzzi S, Cubelli R, Hernandez VM, Della SS. Relational and conjunctive binding functions dissociate in short-term memory. Neurocase 2013; doi:10.1080/13554794.2013.860177.
» https://doi.org/10.1080/13554794.2013.860177
³⁰
de Jager CA, Blackwell AD, Budge MM, Sahakian BJ. Predicting cognitive decline in healthy older adults. Am J Geriatr Psychiatry 2005;13: 735-740.
³¹
Didic M, Barbeau EJ, Felician O, et al. Which memory system is impaired first in Alzheimer's disease? J Alzheimers Dis 2011;27:11-22.
³²
Staresina BP, Davachi L. Object Unitization and Associative Memory Formation Are Supported by Distinct Brain Regions. J Neurosci 2010; 30:9890-9897.
³³
Yang X, Goh A, Chen SHA, Qiu A. Evolution of hippocampal shapes across the human lifespan. Hum Brain Mapp 2013;34:3075-3085.
³⁴
Insausti R, Juottonen K, Soininen H, et al. volumetric analysis of the human entorhinal, perirhinal, and temporopolar cortices. AJNR Am J Neuroradiol 1998;19:659-671.
³⁵
Griffin-Pierce T, Silverberg N, Connor D, et al. Challenges to the recognition and assessment of Alzheimer's disease in American Indians of the southwestern United States. Alzheimers Dement 2008;4:291-299.
³⁶
Wolk DA, Mancuso L, Kliot D, Arnold SE, Dickerson BC. Familiarity-based memory as an early cognitive marker of preclinical and prodromal AD. Neuropsychologia 2013;51:1094-1102.
³⁷
Rentz D, Parra Rodriguez M, Amariglio R, Stern Y, Sperling R, Ferris S. Promising developments in neuropsychological approaches for the detection of preclinical Alzheimer's disease: a selective review. Alzheimers Res Ther 2013;5:58.

1
Associative memory and STM binding refer to two different integrative memory functions. The former entails the formation of complex experiences wherein each constituent element retains its own identity and can be flexibly and individually accessed and retrieved. The latter entails integrative functions responsible for the formation of objects' identity. Such representations are rigid and once the constituent parts are bound, they cannot be accessed individually as they become part of a new object. It is the whole object that can be retrieved.

Publication Dates

Publication in this collection
Apr-Jun 2014

History

Received
13 Mar 2014
Accepted
16 May 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Fields JA, Ferman TJ, Boeve BF, Smith GE. Neuropsychological assessment of patients with dementing illness. Nat Rev Neurol 2011;7:677-687.

[2] ²
Weintraub S, Wicklund AH, Salmon DP. The neuropsychological profile of Alzheimer disease. Cold Spring Harb Perspect Med 2012;2:a006171.

[3] ³
Jacova C, Kertesz A, Blair M, Fisk JD, Feldman HH. Neuropsychological testing and assessment for dementia. Alzheimers Dement 2007; 3:299-317.

[4] ⁴
Nielsen TR, Waldemar G. Dementia in ethnic minorities. Ugeskr Laeger 2010;172:1527-1531.

[5] ⁵
Ardila A, Roselli M, Puente A. Neuropsychological evaluation of the Spanish speaker. Critical Issues in Neuropsychology. New York: Plenum Press; 1994.

[6] ⁶
Rosselli M, Ardila A. The impact of culture and education on non-verbal neuropsychological measurements: a critical review. Brain Cogn 2003;52:326-333.

[7] ⁷
Rosselli M, Ardila A. Effects of age, education, and gender on the Rey-osterrieth complex figure. Clin Neuropsychol 1991;5:370-376.

[8] ⁸
Ardila A, Rosselli M, Rosas P. Neuropsychological assessment in illiterates: visuospatial and memory abilities. Brain Cogn 1989;11:147-166.

[9] ⁹
Becker RE, Greig NH, Giacobini E. Why do so many drugs for Alzheimer's disease fail in development? Time for new methods and new practices? J Alzheimers Dis 2008;15:303-325.

[10] ¹⁰
Parra MA. Cognitive assessment in Alzheimer's disease. Adv Alzheimer's Dis 2013;2:123-125.

[11] ¹¹
Alzheimer's Disease International. World Alzheimer Report: Executive Summary. 2009:12.

[12] ¹²
Parra MA, Sala SD, Abrahams S, Logie RH, Mendez LG, Lopera F. Specific deficit of colour-colour short-term memory binding in sporadic and familial Alzheimer's disease. Neuropsychologia 2011;49:1943-1952.

[13] ¹³
Lopera F, Ardilla A, Martinez A, et al. Clinical features of early-onset Alzheimer disease in a large kindred with an E280A presenilin-1 mutation. JAMA 1997;277:793-799.

[14] ¹⁴
Brickman AM, Paul RH, Cohen RA, et al. Category and letter verbal fluency across the adult lifespan: relationship to EEG theta power. Arch Clin Neuropsychol 2005;20:561-573.

[15] ¹⁵
Mack WJ, Teng E, Zheng L, Paz S, Chui H, Varma R. Category fluency in a latino sample: associations with age, education, gender, and language. J Clin Exp Neuropsychol 2005;27:591-598.

[16] ¹⁶
Rosselli M, Ardila A, Salvatierra J, Marquez M, Matos L, Weekes VA. A cross-linguistic comparison of verbal fluency tests. Int J Neurosci 2002;112:759-776.

[17] ¹⁷
Henry JD, Crawford JR, Phillips LH. Verbal fluency performance in dementia of the Alzheimer's type: a meta-analysis. Neuropsychologia 2004;42:1212-1222.

[18] ¹⁸
Parra MA, Della Sala S, Logie RH, Morcom AM. Neural correlates of shape-color binding in visual working memory. Neuropsychologia 2014; 52:27-36.

[19] ¹⁹
Parra MA, Abrahams S, Logie RH, Mendez LG, Lopera F, Della Sala S. Visual short-term memory binding deficits in familial Alzheimer's disease. Brain 2010;133:2702-2713.

[20] ²⁰
Parra MA, Abrahams S, Fabi K, Logie R, Luzzi S, Della Sala S. Short-term memory binding deficits in Alzheimer's disease. Brain 2009;132: 1057-1066.

[21] ²¹
Logie R, Brockmole JR, Vandenbroucke ARE. Bound Feature Combinations in Visual Short Term Memory are Fragile but Influence Long-Term Learning. Vis Cog 2009;17:160-179.

[22] ²²
Brockmole JR, Logie RH. Age-Related Change in Visual Working Memory: A study of 55,753 Participants Aged 8 to 75. Front Psychol 2013;4.

[23] ²³
Brockmole JR, Parra MA, Della Sala S, Logie R. Do Binding Deficits Account for Age-Related Decline in Visual Working Memory? Psychol Bull Rev 2008;15:543-547.

[24] ²⁴
Old SR, Naveh-Benjamin M. Differential effects of age on item and associative measures of memory: a meta-analysis. Psychol Aging 2008; 23:104-118.

[25] ²⁵
Deary IJ, Johnson W, Starr JM. Are processing speed tasks biomarkers of cognitive aging? Psychol Aging 2010;25:219-228.

[26] ²⁶
Bondi MW, Houston WS, Salmon DP, et al. Neuropsychological deficits associated with Alzheimer's disease in the very-old: discrepancies in raw vs. standardized scores. J Int Neuropsychol Soc 2003;9:783-795.

[27] ²⁷
Sperling RA, Karlawish J, Johnson KA. Preclinical Alzheimer disease [mdash] the challenges ahead. Nat Rev Neurol 2013;9:54-58.

[28] ²⁸
Mitchell KJ, Raye CL, Johnson MK, Greene EJ. An fMRI investigation of short-term source memory in young and older adults. Neuroimage 2006;30:627-633.

[29] ²⁹
Parra MA, Fabi K, Luzzi S, Cubelli R, Hernandez VM, Della SS. Relational and conjunctive binding functions dissociate in short-term memory. Neurocase 2013; doi:10.1080/13554794.2013.860177.
» https://doi.org/10.1080/13554794.2013.860177

[30] ³⁰
de Jager CA, Blackwell AD, Budge MM, Sahakian BJ. Predicting cognitive decline in healthy older adults. Am J Geriatr Psychiatry 2005;13: 735-740.

[31] ³¹
Didic M, Barbeau EJ, Felician O, et al. Which memory system is impaired first in Alzheimer's disease? J Alzheimers Dis 2011;27:11-22.

[32] ³²
Staresina BP, Davachi L. Object Unitization and Associative Memory Formation Are Supported by Distinct Brain Regions. J Neurosci 2010; 30:9890-9897.

[33] ³³
Yang X, Goh A, Chen SHA, Qiu A. Evolution of hippocampal shapes across the human lifespan. Hum Brain Mapp 2013;34:3075-3085.

[34] ³⁴
Insausti R, Juottonen K, Soininen H, et al. volumetric analysis of the human entorhinal, perirhinal, and temporopolar cortices. AJNR Am J Neuroradiol 1998;19:659-671.

[35] ³⁵
Griffin-Pierce T, Silverberg N, Connor D, et al. Challenges to the recognition and assessment of Alzheimer's disease in American Indians of the southwestern United States. Alzheimers Dement 2008;4:291-299.

[36] ³⁶
Wolk DA, Mancuso L, Kliot D, Arnold SE, Dickerson BC. Familiarity-based memory as an early cognitive marker of preclinical and prodromal AD. Neuropsychologia 2013;51:1094-1102.

[37] ³⁷
Rentz D, Parra Rodriguez M, Amariglio R, Stern Y, Sperling R, Ferris S. Promising developments in neuropsychological approaches for the detection of preclinical Alzheimer's disease: a selective review. Alzheimers Res Ther 2013;5:58.

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