Comparison of performance on neuropsychological tests in amnestic Mild Cognitive Impairment and Alzheimer's disease patients

Vale, Patrícia Helena Figueirêdo do; Spíndola, Lívia; Oliveira, Maira Okada de; Armentano, Cristiane Garcia da Costa; Porto, Claudia Sellitto; Brucki, Sonia Maria Dozzi

doi:10.1590/S1980-57642009DN30100009

Abstract

Mild Cognitive Impairment (MCI) can be an intermediate state between normality and dementia in some patients. An early diagnosis, through neuropsychological assessment, could identify individuals at risk of developing dementia.

Objective:

To verify differences in performance on neuropsychological tests among controls, amnestic MCI (aMCI) and Alzheimer’s disease (AD) patients.

Methods:

Sixty-eight AD patients (mean age 73.77±7.24; mean schooling 9.04±4.83; 40 women and 28 men), 34 aMCI patients (mean age 74.44±7.05; mean schooling 12.35±4.01; 20 women) and 60 controls (mean age 68.90±7.48; mean schooling 10.72±4.74; 42 women) were submitted to a neuropsychological assessment composed of tasks assessing executive functions, language, constructive abilities, reasoning and memory.

Results:

There were statistically significant differences in performance across all tests among control, aMCI and AD groups, and also between only controls and AD patients. On comparing control and aMCI groups, we found statistically significant differences in memory tasks, except for immediate recall of Visual Reproduction. There were also statistically significant differences between aMCI and AD groups on tasks of constructive and visuoperceptual abilities, attention, language and memory, except for delayed recall of Visual Reproduction.

Conclusions:

Neuropsychological assessment was able to discriminate aMCI from AD patients in almost all tests except for delayed recall of Visual Reproduction, visual organization (Hooper) and executive functions (WCST); and discriminate controls from AD patients in all tests, and controls from aMCI patients in all memory tests except for immediate recall of Visual Reproduction.

Key words:
Mild Cognitive Impairment; Amnestic Mild Cognitive Impairment; Alzheimer's disease; neuropsychological tests; memory.

Resumo

Comprometimento Cognitivo Leve (CCL) pode ser um estágio entre normalidade e demência em alguns pacientes. Um diagnóstico precoce, com avaliação neuropsicológica, pode identificar indivíduos com risco para desenvolvimento de demência.

Objetivo:

Verificar diferenças no desempenho em testes neuropsicológicos entre controles, pacientes com CCL amnéstico (CCLa) e com doença de Alzheimer (DA).

Métodos:

Sessenta e oito pacientes com DA (média de idade 73,77±7,24; média de escolaridade 9,04±4,83; 40 mulheres), 34 pacientes com CCLa (média de idade 74,44±7,05; média de escolaridade 12,35±4,01; 20 mulheres) e 60 controles (média de idade 68,90±7,48; média de escolaridade 10,72±4,74; 42 mulheres) foram submetidos à ampla avaliação neuropsicológica.

Resultados:

Houve diferenças estatisticamente significativas em todos os testes entre os grupos controle, CCLa e DA, e entre controles e o grupo DA. Na comparação entre controles e pacientes com CCLa foram encontradas diferenças estatisticamente significativas nos testes de memória, exceto na evocação imediata do teste de Reprodução Visual. Foram também encontradas diferenças estatisticamente significativas entre pacientes com CCLa e DA, nas tarefas de habilidades construtivas e visuoperceptuais, atenção, linguagem e memória, com exceção da evocação tardia do teste Reprodução Visual.

Conclusões:

A avaliação neuropsicológica foi capaz de discriminar pacientes com CCLa de pacientes com DA em quase todos os testes exceto na evocação tardia do teste Reprodução Visual, organização visual (Hooper) e funções executivas (WCST); controles de pacientes com DA em todos os testes, e controles de pacientes com CCLa nos testes de memória, exceto na evocação imediata do teste Reprodução Visual.

Palavras-chave:
Comprometimento Cognitivo Leve; Comprometimento Cognitivo Leve Amnéstico; doença de Alzheimer; testes neuropsicológicos; memória.

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References

¹
Petersen RC, Smith GE, Waring SC, et al. Mild Cognitive Impairment: clinical characterization and outcome. Arch Neurol 1999;56:303-308.
²
Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment - beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Int Med 2004;256:240-246.
³
Petersen RC, Doody R, Kurz A, et al. Current concepts in Mild Cognitive Impairment. Arch Neurol 2001;58:1985-1992.
⁴
Arnáiz E, Almkvist O. Neuropsychological features of mild cognitive impairment and preclinical Alzheimer's disease. Acta Neurol Scand 2003;107(Suppl. 179):34-41.
⁵
Dawe B, Procter A. Concepts of mild memory impairment in the elderly and their relationship to dementia - a review. Int J Geriatr Psychiatry 1998;7:473- 479.
⁶
Fischer P, Jungwirth S, Zehetmayer S, et al. Conversion from subtypes of mild cognitive impairment to Alzheimer dementia. Neurology 2007;68:288-291.
⁷
Visser PJ, Kester A, Jolles J, et al. Ten-year risk of dementia in subjects with mild cognitive impairment. Neurology 2006;7:1201-1207.
⁸
Flicker C, Ferris SH, Reisberg B. Mild cognitive impairment in the elderly: predictors of dementia. Neurology 1991;41:1006-09.
⁹
Bäckman L, Small BJ, Fratiglioni L. Stability of the preclinical episodic memory deficit in Alzheimer's disease. Brain 2001;124:96-102.
¹⁰
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto I H. Suggestions of utilization of the Mini-mental state examination in Brazil. Arq Neuropsiquiatr 2003;61:777-781.
¹¹
Nitrini R, Lefèvre BH, Mathias SC, et al. Neuropsychological tests of simple application for diagnosing dementia. Arq Neuropsiquiatr 1994;52:457-465.
¹²
Nitrini R, Carameli P, Porto CS, et al. Avaliação Cognitiva Breve no diagnóstico de doença de Alzheimer leve. Arq Neuropsiquiatr 2005;63;27.
¹³
Pfeffer RI, Kusosaki TT, Harrah Jr CH, Chance JM, Filos S. Measurement of functional Activities in Older Adults in the Community. J Gerontol 1982;37:323-329.
¹⁴
Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de doença de Alzheimer no Brasil: avaliação cognitiva e funcional. Recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arq Neuropsiquiatr 2005;63:720-727.
¹⁵
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3 ed. Ver Washington, DC: American Psychiatric Association;1987.
¹⁶
McKann G, Drachman D, Folstein M, Katzman R, Prince D, Staklan EM. Clinical diagnosis of Alzheimer's Disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services force on Alzheimer's Disease. Neurology 1984;34:939-944.
¹⁷
Petersen RC, Stevens JC, Ganguli M, et al. Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:1133-1142.
¹⁸
Spreen O, Strauss E. A Compendium of Neuropsychological Tests. Administration, Norms, and Commentary. Second Edition. Oxford University Press;1998.
¹⁹
Hooper Visual Organization Test (VOT) Manual. Los Angeles, CA: Western Psychological Services;1983.
²⁰
Raven JC, Raven J, Courth JH. Manual Matrizes Progressivas Coloridas. São Paulo: Casa do Psicólogo;1988.
²¹
Goodglass H, Kaplan E. The assessment of aphasia and related disorders. 2nd ed. Philadelphia: Lea & Febiger;1987.
²²
Radanovic M, Mansur LL, Scaff M. Normative data for the Brazilian population in the Boston Diagnostic Aphasia Examination: influence of schooling. Braz J Med Biol Res 2004;37:1731-1738.
²³
Wechsler D. Teste de Inteligencia para adultos (WAIS). Manual. 2a Edição. Buenos Aires, Argentina. Editorial Paidos;1993.
²⁴
Rey A. Figuras Complexas de Rey. Casa do Psicólogo;1998.
²⁵
Wechsler D. Wechsler Memory Scale. Manual The Psychological Corporation Harcourt Brace Jovanovich;1987.
²⁶
Diniz LFM, Cruz MF, Torres VM, Consenza, RM. Teste de aprendizagem auditivo verbal de Rey: normas para uma população brasileira. Rev Bras Neurol 2000;36:79-83.
²⁷
Mattos P, Lino V, Rizo L, Alfano A, et al. Memory complaints and test performance in health elderly persons. Arq Neuropsiquiatr 2003;61: 920-924.
²⁸
Jorm, AF. A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychol Med 1994;24:145-153.
²⁹
Boeve B, McCormick J, Smith G, et al. Mild Cognitive impairment in the oldest old. Neurology 2008;60:477-480.
³⁰
Mesulam MM. Principles of Behavior and Cognitive Neurology. Second Edition. New York: Oxford;2000:1-540.
³¹
Jacobs DM, Sano M, Dooneief G, Marder K, Bell KL, Stern Y. Neuropsychological detection and characterization of preclinical Alzheimer's Disease. Neurology 1995;45 957-962.
³²
Chen P, Ratcliff G, Phil D, et al. Cognitive tests that best discriminate between presymptomatic AD and those who remain nondemented. Neurology 2000, 55:1847-1853.
³³
Grundeman M, Petersen RC, Ferris SH, et al. Mild Cognitive Impairment can be distinguished from Alzheimer and normal aging for clinical trials. Arch Neurol 2004;61:59-66.
³⁴
Blacker D, Lee H, Muzikansky A, et al. Neuropsychological measures in normal individuals that predict subsequent cognitive decline. Arch Neurol 2007;64:862-871.
³⁵
Perri R, Serra L, Carlesimo GA, Caltagirone C. Preclinical dementia: an Italian multicentre study on amnestic mild cognitive impairment. Dement Geriatr Cogn Disord 2007;23:289-300.
³⁶
Feldman HH, Jacova C. Mild Cognitive Impairment. Am J Geriatr Psychiatry 2005;13:645-655.
³⁷
Kramer JH, Nelson A, Johnson JK, et al. Multiple cognitive deficits in amnestic mild cognitive impairment. Dement Geriatr Cogn Disord 2006;22:306-311.
³⁸
Economou A, Papageorgiou SG, Karageorgiou C, Vassilopoulos D. Nonepisodic memory deficits in amnestic MCI. Cogn Behav Neurol 2007;20:99-106.
³⁹
Rozzini L, Chilovi BV, Conti M, et al. Conversion of amnestic Mild Cognitive Impairment to dementia of Alzheimer type is independent to memory deterioration. Int J Geriatr Psychiatry 2007;22:1217-1222.
⁴⁰
Alescio-Lautier B, Michael BF, Herrera C, et al. Visual and visuospatial short-term memory in mild cognitive impairment and Alzheimer disease: Role of attention. Neuropsychologia 2007;45:1948-1960.
⁴¹
Griffith HR, Netson KL, Harrel LE, Zamrini EY, Brockington JC, Marson DC. Amnestic mild cognitive impairment: diagnostic outcomes and clinical prediction over a two-year time period. J Int Neuropsychol Soc 2006;12:166-175.
⁴²
Tabert MH, Manly JJ, Liu X, et al. Neuropsychological prediction of conversion to Alzheimer disease in patients with mild cognitive impairment. Arch Gen Psychiatry 2006;63: 916-924.
⁴³
Clemént F, Belleville S, Gauthier S. Cognitive complaint in mild cognitive impairment and Alzheimer's disease. J Int Neuropsychol Soc, 2008, 14:222-232.
⁴⁴
Morris JC, Storandt M, Miller JP, et al. Mild cognitive impairment represents early-stage Alzheimer disease. Arch Neurol 2001;58:397-405.
⁴⁵
Nelson AP, O'Connor MG. Mild Cognitive Impairment: A neuropsychological perspective. CNS Spectr 2008;13: 56-64.
⁴⁶
Celone KA, Calhoun VD, Dickerson BC, et al. Alterations in memory networks in mild cognitive impairment and Alzheimer's disease: An independent component analysis. J Neurosci 2006;26:10222-10231.

Publication Dates

Publication in this collection
Jan-Mar 2009

History

Received
20 Oct 2008
Accepted
29 Dec 2008

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

[1] ¹
Petersen RC, Smith GE, Waring SC, et al. Mild Cognitive Impairment: clinical characterization and outcome. Arch Neurol 1999;56:303-308.

[2] ²
Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment - beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Int Med 2004;256:240-246.

[3] ³
Petersen RC, Doody R, Kurz A, et al. Current concepts in Mild Cognitive Impairment. Arch Neurol 2001;58:1985-1992.

[4] ⁴
Arnáiz E, Almkvist O. Neuropsychological features of mild cognitive impairment and preclinical Alzheimer's disease. Acta Neurol Scand 2003;107(Suppl. 179):34-41.

[5] ⁵
Dawe B, Procter A. Concepts of mild memory impairment in the elderly and their relationship to dementia - a review. Int J Geriatr Psychiatry 1998;7:473- 479.

[6] ⁶
Fischer P, Jungwirth S, Zehetmayer S, et al. Conversion from subtypes of mild cognitive impairment to Alzheimer dementia. Neurology 2007;68:288-291.

[7] ⁷
Visser PJ, Kester A, Jolles J, et al. Ten-year risk of dementia in subjects with mild cognitive impairment. Neurology 2006;7:1201-1207.

[8] ⁸
Flicker C, Ferris SH, Reisberg B. Mild cognitive impairment in the elderly: predictors of dementia. Neurology 1991;41:1006-09.

[9] ⁹
Bäckman L, Small BJ, Fratiglioni L. Stability of the preclinical episodic memory deficit in Alzheimer's disease. Brain 2001;124:96-102.

[10] ¹⁰
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto I H. Suggestions of utilization of the Mini-mental state examination in Brazil. Arq Neuropsiquiatr 2003;61:777-781.

[11] ¹¹
Nitrini R, Lefèvre BH, Mathias SC, et al. Neuropsychological tests of simple application for diagnosing dementia. Arq Neuropsiquiatr 1994;52:457-465.

[12] ¹²
Nitrini R, Carameli P, Porto CS, et al. Avaliação Cognitiva Breve no diagnóstico de doença de Alzheimer leve. Arq Neuropsiquiatr 2005;63;27.

[13] ¹³
Pfeffer RI, Kusosaki TT, Harrah Jr CH, Chance JM, Filos S. Measurement of functional Activities in Older Adults in the Community. J Gerontol 1982;37:323-329.

[14] ¹⁴
Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de doença de Alzheimer no Brasil: avaliação cognitiva e funcional. Recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arq Neuropsiquiatr 2005;63:720-727.

[15] ¹⁵
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3 ed. Ver Washington, DC: American Psychiatric Association;1987.

[16] ¹⁶
McKann G, Drachman D, Folstein M, Katzman R, Prince D, Staklan EM. Clinical diagnosis of Alzheimer's Disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services force on Alzheimer's Disease. Neurology 1984;34:939-944.

[17] ¹⁷
Petersen RC, Stevens JC, Ganguli M, et al. Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:1133-1142.

[18] ¹⁸
Spreen O, Strauss E. A Compendium of Neuropsychological Tests. Administration, Norms, and Commentary. Second Edition. Oxford University Press;1998.

[19] ¹⁹
Hooper Visual Organization Test (VOT) Manual. Los Angeles, CA: Western Psychological Services;1983.

[20] ²⁰
Raven JC, Raven J, Courth JH. Manual Matrizes Progressivas Coloridas. São Paulo: Casa do Psicólogo;1988.

[21] ²¹
Goodglass H, Kaplan E. The assessment of aphasia and related disorders. 2nd ed. Philadelphia: Lea & Febiger;1987.

[22] ²²
Radanovic M, Mansur LL, Scaff M. Normative data for the Brazilian population in the Boston Diagnostic Aphasia Examination: influence of schooling. Braz J Med Biol Res 2004;37:1731-1738.

[23] ²³
Wechsler D. Teste de Inteligencia para adultos (WAIS). Manual. 2a Edição. Buenos Aires, Argentina. Editorial Paidos;1993.

[24] ²⁴
Rey A. Figuras Complexas de Rey. Casa do Psicólogo;1998.

[25] ²⁵
Wechsler D. Wechsler Memory Scale. Manual The Psychological Corporation Harcourt Brace Jovanovich;1987.

[26] ²⁶
Diniz LFM, Cruz MF, Torres VM, Consenza, RM. Teste de aprendizagem auditivo verbal de Rey: normas para uma população brasileira. Rev Bras Neurol 2000;36:79-83.

[27] ²⁷
Mattos P, Lino V, Rizo L, Alfano A, et al. Memory complaints and test performance in health elderly persons. Arq Neuropsiquiatr 2003;61: 920-924.

[28] ²⁸
Jorm, AF. A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychol Med 1994;24:145-153.

[29] ²⁹
Boeve B, McCormick J, Smith G, et al. Mild Cognitive impairment in the oldest old. Neurology 2008;60:477-480.

[30] ³⁰
Mesulam MM. Principles of Behavior and Cognitive Neurology. Second Edition. New York: Oxford;2000:1-540.

[31] ³¹
Jacobs DM, Sano M, Dooneief G, Marder K, Bell KL, Stern Y. Neuropsychological detection and characterization of preclinical Alzheimer's Disease. Neurology 1995;45 957-962.

[32] ³²
Chen P, Ratcliff G, Phil D, et al. Cognitive tests that best discriminate between presymptomatic AD and those who remain nondemented. Neurology 2000, 55:1847-1853.

[33] ³³
Grundeman M, Petersen RC, Ferris SH, et al. Mild Cognitive Impairment can be distinguished from Alzheimer and normal aging for clinical trials. Arch Neurol 2004;61:59-66.

[34] ³⁴
Blacker D, Lee H, Muzikansky A, et al. Neuropsychological measures in normal individuals that predict subsequent cognitive decline. Arch Neurol 2007;64:862-871.

[35] ³⁵
Perri R, Serra L, Carlesimo GA, Caltagirone C. Preclinical dementia: an Italian multicentre study on amnestic mild cognitive impairment. Dement Geriatr Cogn Disord 2007;23:289-300.

[36] ³⁶
Feldman HH, Jacova C. Mild Cognitive Impairment. Am J Geriatr Psychiatry 2005;13:645-655.

[37] ³⁷
Kramer JH, Nelson A, Johnson JK, et al. Multiple cognitive deficits in amnestic mild cognitive impairment. Dement Geriatr Cogn Disord 2006;22:306-311.

[38] ³⁸
Economou A, Papageorgiou SG, Karageorgiou C, Vassilopoulos D. Nonepisodic memory deficits in amnestic MCI. Cogn Behav Neurol 2007;20:99-106.

[39] ³⁹
Rozzini L, Chilovi BV, Conti M, et al. Conversion of amnestic Mild Cognitive Impairment to dementia of Alzheimer type is independent to memory deterioration. Int J Geriatr Psychiatry 2007;22:1217-1222.

[40] ⁴⁰
Alescio-Lautier B, Michael BF, Herrera C, et al. Visual and visuospatial short-term memory in mild cognitive impairment and Alzheimer disease: Role of attention. Neuropsychologia 2007;45:1948-1960.

[41] ⁴¹
Griffith HR, Netson KL, Harrel LE, Zamrini EY, Brockington JC, Marson DC. Amnestic mild cognitive impairment: diagnostic outcomes and clinical prediction over a two-year time period. J Int Neuropsychol Soc 2006;12:166-175.

[42] ⁴²
Tabert MH, Manly JJ, Liu X, et al. Neuropsychological prediction of conversion to Alzheimer disease in patients with mild cognitive impairment. Arch Gen Psychiatry 2006;63: 916-924.

[43] ⁴³
Clemént F, Belleville S, Gauthier S. Cognitive complaint in mild cognitive impairment and Alzheimer's disease. J Int Neuropsychol Soc, 2008, 14:222-232.

[44] ⁴⁴
Morris JC, Storandt M, Miller JP, et al. Mild cognitive impairment represents early-stage Alzheimer disease. Arch Neurol 2001;58:397-405.

[45] ⁴⁵
Nelson AP, O'Connor MG. Mild Cognitive Impairment: A neuropsychological perspective. CNS Spectr 2008;13: 56-64.

[46] ⁴⁶
Celone KA, Calhoun VD, Dickerson BC, et al. Alterations in memory networks in mild cognitive impairment and Alzheimer's disease: An independent component analysis. J Neurosci 2006;26:10222-10231.

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