Skip to main content
SpringerLink
Log in

Measuring cognition in advanced Alzheimer’s disease for clinical trials

  • Conference paper
Ageing and Dementia Current and Future Concepts

Part of the book series: Journal of Neural Transmission. Supplementa ((NEURAL SUPPL,volume 62))

Abstract

Measurement of cognitive dysfunction and treatment response in the early stages of Alzheimer’s disease (AD) has used such scales as the MiniMental State Examination (MMSE) and the AD Assessment Scale (ADAS). With the exception of clinical rating scales, however, there are only a few objective measures of cognition for tracking progression in advanced AD. Given renewed interest in potential therapies for advanced AD, objective measures of cognition are important for the adequate evaluation of change due to AD progression or therapy. Several cognitive measures for advanced AD are reviewed. One measure, the Severe Impairment Battery (SIB) is reviewed in detail. Preliminary analyses from a trial of memantine show significant change on the SIB in memory (p < 0.001) and visuospatial functions (p < 0.02) over six-months with a trend for language and praxis. Data from a donepezil trial also highlight the importance of accurate assessment in advanced AD.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Albert M, Cohen C (1992) The test for severe impairment: an instrument for the assessment of patients with severe cognitive dysfunction. J Am Geriatr Soc 40: 449–453

    CAS  PubMed  Google Scholar 

  • Auer SR, Reisberg B (1996) Reliability of the modified ordinal scales of psychological development: a cognitive assessment battery for severe dementia. Int Psychogeriatr 8: 225–231

    Article  CAS  PubMed  Google Scholar 

  • Auer SR, Sclan SG, Yaffee RA, Reisberg B (1994) The neglected half of Alzheimer’s disease: cognitive and functional concomitants of severe dementia. J Am Geriatr Soc 42: 1266–1272

    CAS  PubMed  Google Scholar 

  • Ashford JW, Schmitt FA (2001) Modeling the time-course of Alzheimer dementia.Curr Psychiatr Reports 3: 20–28

    Article  CAS  Google Scholar 

  • Ashford JW, Schmitt FA, Kumar V (1998) Diagnosis of Alzheimer’s disease.Psychiatr Ann 26: 262–268

    Google Scholar 

  • Barner EL, Gray SL (1998) Donepezil use in Alzheimer disease.Ann Pharmacother 32: 70–77

    Article  CAS  PubMed  Google Scholar 

  • Bums A, Jacoby R, Levy R (1991) Progression of cognitive impairment in Alzheimer’s disease.J Am Geriatr Soc 39: 39–45

    Google Scholar 

  • Cummings JL, Benson DF (1992) Psychological dysfunction accompanying subcortical dementias.Annu Rev Med 3: 953–961

    Google Scholar 

  • Doody RS, Dunn JK, Clark CM, Farlow M, Foster NL, Liao T, Gonzales N, Lai E, Massman P (2001) Chronic donepezil treatment is associated with slowed cognitive decline in Alzheimer’s disease.Dement Geriatr Cogn Disord 12: 295–300

    Article  CAS  PubMed  Google Scholar 

  • Edland SD (2000) Blomqvist revisited: how and when to test the relationship between level and longitudinal rate of change.Stat Med 19: 1441–1452

    Article  CAS  PubMed  Google Scholar 

  • Farlow M, Anand R, Messina J Jr, Hartman R, Veach J (2000) A 52-week study of the efficacy of rivastigmine in patients with mild to moderately severe Alzheimer’s disease.Eur Neuro l44: 236–241

    Article  Google Scholar 

  • Feldman H, Gauthier S, Hecker J, Vellas B, Subbiah P, Whalen E (2001) A 24-week, randomized, double-blind study of donepezil in moderate to severe Alzheimer’s disease.Neurology 57: 613–620

    Article  CAS  PubMed  Google Scholar 

  • Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state: a practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res 12: 189–198

    Article  CAS  PubMed  Google Scholar 

  • Galasko DR, Schmitt FA, Jin S, Saxton J, Bennett D, Sano M, Ferris SH (2000) Detailed assessment of cognition and activities of daily living in moderate to severe Alzheimer’s disease.Neurobiol Aging 21 (lS): 168

    Article  Google Scholar 

  • Guy W. 028 CGI (1976) Clinical global impressions.In:Assessment manual for psychopharmacology, rev edn. National Institute of Mental Health, Rockville, Maryland, pp 217–222

    Google Scholar 

  • Harrell LE, Marson D, Chatterjee A, Parrish JA (2000) The severe mini-mental state examination: a new neuropsychologic instrument for the bedside assessment of severely impaired patients with Alzheimer’s disease.Alzheimer Dis Assoc Disord 14:168–175

    Article  CAS  PubMed  Google Scholar 

  • Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL (1982) A new clinical scale for the staging of dementia.Br J Psychiatry 140: 566–572

    Article  CAS  PubMed  Google Scholar 

  • Jarvik LF, Berg L, Bartus R, Heston L, Leith N, Phelps C, Shader R, Whitehouse P (1990) Clinical drug trials in Alzheimer’s disease: what are some of the issues?Alzheimer Dis Assoc Disord 4: 193–202

    Article  CAS  PubMed  Google Scholar 

  • Knapp MI, Knopman DS, Solomon PR, Pendlebury WW, Davis CS, Gracon SI (1994) A 30-week randomized controlled trial of high dose tacrine in patients with Alzheimer’s disease.JAMA 271: 985–991

    Article  CAS  PubMed  Google Scholar 

  • Mackell JA, Ferris SH, Mohs R, Schneider L, Galasko D, Whitehouse P, et al (1997) Multicenter evaluation of new instruments for Alzheimer’s disease clinical trials: summary of results.Alzheimer Dis Assoc Disord 11 [Suppl 2]: 2–7

    Google Scholar 

  • Mattis S (1988) Dementia rating scale professional manual. Psychological Assessment Resources Inc, Odessa, Florida

    Google Scholar 

  • Mendiondo MS, Ashford JW, Kryscio RJ, Schmitt FA (2000) Modelling mini mental state examination changes in Alzheimer’s disease.Stat Med 19: 1607–1616

    Article  CAS  PubMed  Google Scholar 

  • Mesulam MM (1996) The systems-level organization of cholinergic innervation in the human cerebral cortex and its alterations in Alzheimer’s disease.Prog Brain Res 109: 285–297

    Article  CAS  PubMed  Google Scholar 

  • Mohs RC (1996) Comprehensive and neuropsychologic evaluations. The Alzheimer’s disease assessment scale.Int Psychogeriatr 8: 195–203

    Article  CAS  PubMed  Google Scholar 

  • Mohs RC, Cohen L (1988) Alzheimer’s disease assessment scale (ADAS).Psychopharmacol Bull 24: 627–628

    CAS  PubMed  Google Scholar 

  • Morris JC, Cyrus PA, Orazem J, Mas J, Bieber F, Ruzicka BB, Gulanski B (1998) Metrifonate benefits cognitive, behavioral, and global function in patients with Alzheimer’s disease.Neurology 50: 1222–1230

    Article  CAS  PubMed  Google Scholar 

  • Panisset M,Roudier M, Saxton J, Boller F (1994) Severe impairment battery ¨C a neuropsychological test for severely demented patients.Arch Neurol5l: 41--45

    Article  Google Scholar 

  • Peavy GM, Salmon DP, Rice VA, Galasko D, Samuel W, Taylor KI, Ernesto C, Butters N, Thai L (1996) Neuropsychological assessment of severely demeted elderly: the severe cognitive impairment profile.Arch Neurol 53: 367–372

    Article  CAS  PubMed  Google Scholar 

  • Raskind MA, Peskind ER, Wessel T, Yuan W (2000) Galantamine in AD: a 6-month randomized, placebo-controlled trial with a 6-month extension. The Galantamine USA-l Study Group.Neurology 54: 2261–2268

    Article  CAS  PubMed  Google Scholar 

  • Reisberg B (1988) Functional assessment staging (FAST). Psychopharmacol Bull 24: 653659 Reisberg B, Ferris SH, de Leon MJ, Crook T (1982) The global deterioration scale for assessment of primary degenerative dementia. Am J Psychiatry 139: 1136–1139

    Google Scholar 

  • Reisberg B, Windscheif U, Ferris SH, Hingorani VH, Stoffler A, Mobius HJ (2000) Memantine in moderately severe to severe Alzheimer’s disease (AD): results of a placebo-controlled 6-month trial.Neurobiol Aging 21 (IS): S275

    Article  Google Scholar 

  • Rogers SL, Friedhoff LT (1996) The efficacy and safety of donepezil in patients with Alzheimer’s disease: results of a U.S. multicentre, randomized, double-blind, placebo controlled trial.Dementia 7: 293–303

    CAS  PubMed  Google Scholar 

  • Rogers SL, Friedhoff LT (1998) Long term efficacy and safety of donepezil in the treatment of Alzheimer’s disease: an interim analysis of the results of a US multicentre open label extension study.Eur Neuropsychopharmaco l8: 67–75

    Article  Google Scholar 

  • Rogers SL, Doody RS, Mohs RC, Friedhoff LT (1998a) Donepezil improves cognition and global function in Alzheimer disease: a IS-week, double-blind, placebocontrolled study. Donepezil Study Group.Arch Intern Med 158: 1021–1031

    Article  CAS  PubMed  Google Scholar 

  • Rogers SL, Farlow MR, Doody RS, Mohs R, Friedhoff LT (1998b) A 24-week, doubleblind, placebo-controlled trial of donepezil in patients with Alzheimer’s disease. Donepezil Study Group.Neurology 50: 136–145

    Article  CAS  PubMed  Google Scholar 

  • Rosen WG, Mohs RC, Davis KL (1984) A new rating scale for Alzheimer’s disease.Am J Psychiatry 141: 1356–1364

    CAS  PubMed  Google Scholar 

  • Rosier M, Anand R, Cicin-Sain A, Gauthier S, Agid Y, Dal-Bianco P, Stahelin HB, Hartman R, Gharabawi M (1999) Efficacy and safety of rivastigmine in patients with Alzheimer’s disease: international randomised controlled trial.BMJ 318: 633–638

    Google Scholar 

  • Sano M, Growdon J, Klauber M, Erneston C, Schafer P, Woodbury P, Grundman M, Thai L (1995) Expanding the severity range of patients in clinical trials for Alzheimer’s disease: a multicenter clinical trial of selegiline and alpha tocopherol. Neurology 45 [Suppl 4]: A289

    Google Scholar 

  • Sano M, Ernesto C, Klauber M, Schafer K, Woodbury P, Grundman M, Thai L, Alzheimer’s Disease Cooperative Study Group (1996) Using the ADAS to assess change among moderately and severely impaired AD patients.J Int Neuropsychol Soc 2: 13

    Google Scholar 

  • Sano M, Growdon J, Thomas C, Ernesto K, Schafer K, Woodbury P, Grundman M, Thai L (1996) Evaluation of efficacy measures in clinical trials for Alzheimer’s disease: does psychometric test performance predict clinically relevant outcomes?Neurology 46: A218

    Google Scholar 

  • Saxton J, McGonigle-Gibson KL, Swihart AA, Miller VJ, Boller F (1990) Assessment of the severely impaired patient: description and validation of a new neuropsychological test battery.J Consult Clin Psycho l2: 298–303

    Google Scholar 

  • Saxton J, Swihart A, McGonigle-Gibson KL, Miller VJ, Boller F (1990) Assessment of the severely impaired patient: description and validation of a new neuropsychological test battery.Psychol Assess 2: 298–303

    Article  Google Scholar 

  • Saxton J, McGonigle KL, Swihart AA, Boller F (1993) The severe impairment battery manual. Thames Valley Test Company, Bury St. Edmunds

    Google Scholar 

  • Saxton J, McGonigle KL, Swihart AA, Boller F (1993) The Severe Impairment Battery.The University of Pittsburgh of the Commonwealth System of Higher Education (eds) Thames Valley Test Company, Suffolk, pp 1–16

    Google Scholar 

  • Schmitt FA, Ashford W, Ernesto C, Saxton J, Schneider LS, Clark CM, Ferris SH, Mackell JA, Schafer K, Thai LJ (1997) The severe impairment battery: concurrent validity and the assessment of longitudinal change in Alzheimer’s disease. The Alzheimer’s Disease Cooperative Study.Alzheimers Dis Assoc Disord l1 [Suppl 2]: 51–56

    Article  Google Scholar 

  • Scian SG, Reisberg B (1992) Functional assessment staging (FAST) in Alzheimer’s disease: reliability, validity, and ordinality. Int Psychoger 4 [Suppl1]: 55–69

    Google Scholar 

  • Volicer L, Hurley AC, Lathi DC, Kowall NW (1994) Measurement of severity in advanced Alzheimer’s disease.J Gerontol 49: M223–M226

    Article  CAS  PubMed  Google Scholar 

  • Whitehouse PJ (1987) Clinical and neurochemical consequences of neuronal loss in the nucleus basalis of Meynert in Parkinson’s disease and Alzheimer’s disease.Adv Neuro l45: 393–397

    Google Scholar 

  • Whitehouse PJ, Price DL, Struble RG, Clark AW, Coyle JT, Delon MR (1982) Alzheimer’s disease and senile dementia: loss of neurons in the basal forebrain.Science 215: 1237–1239

    Article  CAS  PubMed  Google Scholar 

  • Wild KV, Kaye JA (1998) The rate of progression of Alzheimer’s disease in the later stages: evidence from the severe impairment battery.J Int Neuropsychol Soc 4: 512–516

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sanders-Brown Center on Aging,Department of Psychiatry, University of Kentucky Medical Center, Lexington, KY, 40536-0230, USA

    F. A. Schmitt Ph.D. & J. W. Ashford

  2. Department of Neurology, University of Kentucky Medical Center, Lexington, KY, USA

    F. A. Schmitt Ph.D.

  3. Veterans Administration Medical Center, University of Kentucky, Lexington, KY, USA

    J. W. Ashford & A. Stöffler

  4. Department of Psychology, University of Kentucky, Lexington, KY, USA

    F. A. Schmitt Ph.D. & D. Cragar

  5. Department of Psychiatry, New York University School of Medicine, New York, NY, USA

    B. Reisberg

  6. R & D Pharma, Merz + Co, Frankfurt, Federal Republic of Germany

    S. Ferris & H.-J. Möbius

Authors
  1. F. A. Schmitt Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Cragar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. W. Ashford
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Reisberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Ferris
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H.-J. Möbius
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Stöffler
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Institut für Klinische Neurobiologie, Kenyongasse 18/7, A-1070, Wien, Austria

    Kurt A. Jellinger

  2. Universitätsklinik für Neurologie, Auenbruggerplatz 22, A-8036, Graz, Austria

    Reinhold Schmidt

  3. JWS Research Forschungslabor GmbH, Rankengasse 28, A-8020, Graz, Austria

    Manfred Windisch

Rights and permissions

Reprints and permissions

Copyright information

© 2002 Springer-Verlag Wien

About this paper

Cite this paper

Schmitt, F.A. et al. (2002). Measuring cognition in advanced Alzheimer’s disease for clinical trials. In: Jellinger, K.A., Schmidt, R., Windisch, M. (eds) Ageing and Dementia Current and Future Concepts. Journal of Neural Transmission. Supplementa, vol 62. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6139-5_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-6139-5_14

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-83796-2

  • Online ISBN: 978-3-7091-6139-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation