Agenda 3:00 PMIntroduction to Workshop Barry Reisberg, M.D. 3:05 PM Cognitive dynamics: how...
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Transcript of Agenda 3:00 PMIntroduction to Workshop Barry Reisberg, M.D. 3:05 PM Cognitive dynamics: how...
Agenda 3:00 PM Introduction to Workshop Barry Reisberg, M.D.
3:05 PM Cognitive dynamics: how variability in brain Kenneth Rockwood M.D., FRCPC, FRCPfunction influences the risk of cognitive decline
3:35 PM Current Knowledge of Methodologies for Barry Reisberg, M.D.Clinical Trials in Pre-MCI Persons with SubjectiveCognitive Impairment (SCI)
4:25 PM Discussion of Current Knowledge and Joel Sadavoy M.D., FRCPCMethodologies
4:35 PM Discussion of Clinical Instrumentation for Barry Reisberg, M.D.Subject Selection and Assessment
4:55 PM Subject Interview Workshop Faculty and Participants
5:25 PM Final Discussion Joel Sadavoy M.D., FRCPC
Current Knowledge
of
Methodologies
for
Clinical Trials
in
Pre-MCI Persons
with
Subjective Cognitive Impairment
(SCI)
Barry Reisberg, M. D.
Professor of Psychiatry
Director, Fisher Alzheimer's Disease Program
Clinical Director, Aging & Dementia Research Center
Director, Clinical Core, NYU Alzheimer's Disease Center
New York University School of Medicine
Barry Reisberg, M.D.
Adjunct ProfessorCenter for Studies in Aging, Faculty of MedicineMcGill University, Montreal, Canada(1993 – present)
MemberADI Medical & Scientific Advisory Panel (MSAP)(1997 – present)
Founder and ChairADI Prevention Work Group
Research Support(1978 to Present)
USDHHS
National Institute on Aging
AG 03051, AG 08051, AG 11505, AG 09127, AG 01344
National Institute on Mental Health
MH 43486, MH 38275, MH 29590, MH 42216, MH 35976, MH 40410, MH 32577, MH 29590
National Institute of Neurologic Diseases and StrokeNS 15638
Adminstration on AgingAR 2160, AM 2552
FOUNDATIONZachary and Elizabeth M. Fisher Medical FoundationWilliam and Sylvia Silberstein Bequest
Mr. Leonard LitwinThe Louis J. Kay and June E. Kay Foundation
Disclosures
I am the developer, and copyright holder
with respect to some of the instruments
and procedures
which I will be discussing.
Copyrights
These include the:
Global Deterioration Scale (GDS)
Functional Assessment Staging (FAST) Brief Cognitive Rating Scale (BCRS) Behavioral Pathology in Alzheimer’s Disease
Assessment (BEHAVE-AD)
I have coined the terms and, with my associates, developed the concepts behind:
Mild Cognitive Impairment
Subjective Cognitive Impairment
Disclosures
My measures have been made freely available to:
All researchers, academics and students
Governmental bodies e.g., US: Medicare (Center for Medicare and Medicaid Services [CMS])
US Veterans Administration 5 Canadian Provinces
Not for profit associations e.g., Alzheimer’s Association
American Psychiatric Association
> 90 % of currently used Alzheimer’s disease medications in the U.S.
have been approved by the FDA in pivotal trials employing methods (scales)
developed by myself and my colleagues
Collaborators
Primary – NYU Institute for Basic Research- Steven H. Ferris, Ph.D. Staten Island, N.Y. Mony J. de Leon, Ed.D. Jerzy Weigel, DVM
Other NYU Collaborators Henry Wisniewski, M.D., Ph.D.
Emile H. Franssen, M.D. Maciek Bobinski, M.D.
Liduin Souren, RN, MSN MAS Austria Sunnie Kenowsky, DVM Stefanie Auer, Ph.D.
Alan Kluger, Ph.D. Tohoku University, Sendai, Japan Carol Torossian, Psy.D. Masumi Shimada, O.T. Isabel Monteiro, M.D. Kenichi Meguro, M.D., Ph.D.
Industry Collaborators Ravi Anand, M.D. (Switzerland & US) Hans Jorg Mobius (Frankfurt, Germany) Albrecht Stoëffler (Frankfurt, Germany)
Risk Factors for AD.
Now Appear to Operate
Early in Life
For example:
ApoE – є4 allele
genotypic risk for AD
Reiman, et al., Functional brain abnormalities in young adults at genetic risk for late-onset Alzheimer's dementia., Proc Natl Acad Sci U S A., 2004 101(1):284-9.
http--www_kavlifoundation_org-uploads 1215817302_Moser_EntorhinalCortex_jpg.mht
• Development of neurofibrillary changes (n=2369)
Braak, H. & Braak, E., Aspects of cortical destruction in Alzheimer’s disease, in Hyman, B.T., Duykaerts, C., & Christen, Y. (Eds.), Connections Cognition and Alzheimer’s Disease, Springer-Verlag, Berlin Heidelberg, 1997.
GDS Stage 3 Mild Cognitive Impairment1,2
Earliest subtle deficits
Objective evidence of memory deficit obtained only with an intensive
interview
Decreased performance in demanding employment and social settings
1 Reisberg, et al., Drug Development Research, 1988; 15:101-114. 2 Flicker, C., Ferris, S.H., Reisberg, B. Mild Cognitive Impairment in the elderly:
prediction of dementia. Neurology, 1991, 41:1006-1009.
Psychometric/Mental Status/Behavior
SCI vs MCI
Significant differences on the:
MMSEBlessed Dementia ScaleBlessed et al., information test, memory test, and concentration
test, WAIS vocabulary scores
Paragraphs, initial and delayed recall testsPaired associates, initial and delayed recall Designs test Shopping list selective reminding testDigits backward recallDigit symbol substitution test Finger tapping speed (mean R & L)Comprehensive psychometric test
Reisberg, et al., Drug Dev Res, 1988; 15:101-114.
No Cognitive Subjective Cognitive Mild Cognitive
Impairment Impairment Impairment
(NCI) (SCI) (MCI)
Kluger et al., Journal of Geriatric Psychiatry and Neurology, 1999; 12: 168-179
This study verified our earlier estimatethat the MCI stage of eventual AD lasts approximately 7 years in otherwise healthy persons.
This estimate of duration is almost precisely in the midpoint of the timecourse observed for MCI in subsequent worldwide studies.
Selected Studies of Clinically Defined MCI (GDS stage 3) with Ddx from Normal Aging and/or Dementia, 1983-2001
Abbrev. Citation* Modality Finding
Reisberg, et al., 1983 Clinically assessed Ddx MCI vsPsychopharm. Bull. modalities e.g., SCI &
concentration, Mild ADReisberg & Ferris, 1988, calculation, etc. Psychopharm. Bull.
Reisberg, et al., 1992, Int. Psychoger.
Reisberg, et al., 1988, Mental status, Ddx MCI Drugs. Dev. Res. Psychometric tests vs SCI &
Mild AD
Abbrev. Citation* Modality Finding
Reisberg, et al., 1985, Subjective complaints, Ddx MCI
in B. Stanley (ed.), American subject & spouse rated, vs SCI &
Psychiatric Press insight & denial Mild AD
Reisberg, et al., 1989 Nature of behavioral Ddx MCI Bull. Clin. Neurosci. disturbances vs. SCI and
and Mild AD
de Leon, et al., 1989, MRI hippocampal MCI atrophy Lancet. atrophy predicts ADde Leon, et al., 1993, Am. J. Neuroradiology
Franssen et al., 1991, Neurological reflexes ↑ DTRs, glabellar Arch. Neurology blink &
palmomental reflexes in
MCIvs NL aged
Abbrev. Citation* Modality Finding
Prichep, et al., 1994, Neurobiol. QEEG ↑ theta activ. InAging MCI vs. SCI
Kluger, et al., 1997, Motor measures Ddx MCI vs. Journ. Gerontology SCI &
Mild AD
Franssen et al., 1999, Equilibrium and coordination Ddx MCI Joun. Am. Geriatr. Soc. measures vs NL aged
Reisberg, et al., 2001, ADLs, Ddx MCI Int. Psychogeriatrics 13 areas vs SCI and
Mild AD
*Complete citations in Reisberg, Ferris, Kluger, Franssen, Wegiel, and de Leon, Mild cognitive impairment (MCI): a historical perspective, International Psychogeriatrics, 20:1, 18-31, 2008.
MCIPeterson, et al., 20011
Memory complaint
Objective memory impairment
Normal general cognitive function
Intact activities of daily living
Not demented
1 Peterson, Stevens, Ganguli, et al., Neurology, 56:1133-1142.
MCI International Working Group
(IWG)
Criteria 2004
* Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, Nordberg A, Bäckman L, Albert M, Almkvist O, Arai H, Basun H, Blennow K, de Leon M, DeCarli C, Erkinjuntti T, Giacobini E, Graff C, Hardy J, Jack C, Jorm A, Ritchie K, van Duijn C, Visser P, Petersen RC. Mild cognitive impairment--beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J. Intern. Med., 2004; 256: 240-6.
MCI
International Working Group
(IWG)
Criteria (2004)*
Do not require self report of decline
Instead suggest that MCI subjects have:
“self and/or informant report and
impairment on objective cognitive tests
and/or,
evidence of decline over time on objective cognitive tasks”
Global Deterioration Scale Stage Diagnosis and Nl Nl MCI Mild Mod Mod- Severity without with AD AD Severe SCI SCI AD
Questions referring to the subject’s status. Category 1: memory functioning: Query 1: What kinds of problems do you (does your spouse) have with memory?
Recommend a clinical, rather than a psychometric definition of MCI
Functioning
“A wide range of cognitive functions appear to decline … including memory, attention, language, visuospatial skill, perceptual speed and executive functioning.”
Entirely compatible with the original GDS Stage 3 MCI definition.
* Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, Nordberg A, Bäckman L, Albert M, Almkvist O, Arai H, Basun H, Blennow K, de Leon M, DeCarli C, Erkinjuntti T, Giacobini E, Graff C, Hardy J, Jack C, Jorm A, Ritchie K, van Duijn C, Visser P, Petersen RC. Mild cognitive impairment--beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J. Intern. Med., 2004; 256: 240-6.
Adapted from Reisberg, Dementia, Adapted from Reisberg, Dementia, GeriatricsGeriatrics, 1986; 41(4): 30-46., 1986; 41(4): 30-46.
Subjective Cognitive ImpairmentClinical Diagnosis Normal Adult Subjective Cognitive Impairment Mild Cognitive Impairment Mild Mod Mod to Seve Severe
NL SCI MCI AD AD AD AD
Subjective Cognitive Impairment
Very common
Jonker, et al., 2000
Reviewed 3 community based studies
of persons ≥ 65 years of age
Prevalence = 25% to 56%
Subjective Cognitive Impairment
• Quite troubling
For the past 30 years,
~ 1/3 of the persons presenting
at the NYU School of Medicine,
Aging and Dementia Research Center
have SCI
These people frequently want help.
Subjective Cognitive Impairment
Persons with these symptoms need to be
differentiated from –
Healthy non-SCI persons
Persons with MCI
The Global Deterioration Scale (GDS)1 which we have been using for the past 30 years makes these distinctions.
Other elements of the GDS Staging System also make these distinctions.
Brief Cognitive Rating Scale (BCRS)Functional Assessment Staging (FAST)
1Reisberg, B., Ferris, S.H., de Leon, M.J., and Crook, T., The global deterioration scale for
assessment of primary degeneration dementia. American Journal of Psychiatry, 1982;
139:1136-1139.
GDS Stage 1
Healthy older persons
Free of subjective complaints of cognitive
impairment
Free of objective evidence of cognitive
impairment
GDS Stage 2
Subjective complaints of memory deficit.
e.g., forgetting names
one formerly knew well
Forgetting where one has placed familiar objects.
No objective evidence of memory deficit on clinical interview
No objective deficit in employment or social situations
GDS and FAST Stages of ADGDS and FAST Stages of AD GDSGDS
StageStageFASTFASTStageStage
FAST FAST Functional AssessmentFunctional Assessment
Subjective complaints only, e.g., forgetting names, forgetting location of objects
22. SCI
Duration of the SCI stageHypothesized duration = 15 years (Reisberg, 1986)Longitudinal Study of 44 GDS Stage 2 Subjects Followed for 8.9 ± 1.8 Years(Prichep, et al., 2006)
The hypothesized mean duration of the subjective cognitive impairment (SCI) stage, synonymous with Global Deterioration Scale (GDS) stage 2, was published in Reisberg, B. (1986). Dementia: a systematic approach to identifying reversible causes. Geriatrics, 41(4), 30-46. The observed results for the duration of the SCI stage, synonymous with GDS stage 2, are calculated from Prichep, L.S., et al. (1994). Quantitative EEG correlates of cognitive deterioration in the elderly. Neurobiology of Aging, 15, 85-90.
Result: For a stage with a 15 year duration, the observed result differed from the hypothesized result by 2 %.
Reisberg, B. and Gauthier, S., International Psychogeriatrics, 20:1, 1-16, 2008..
59.33% 61.36%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
Percentage of Subjects
Declining at Follow-Up
Hypothesized Observed
Cross Sectional Studies
are
Beginning to Show Differences
between
SCI Subject Groups
and
Healthy, Non-SCI
as well as MCI
Subjects Groups
Prichep, et al., Neurobiology of Aging, 1994, 15: 85-90.
Physiologic Differences between GDS Stage 2 SCI Subjects
and
GDS Stage 1 Subjects with No Cognitive Impairment (NCI)
Physiologic ChangesHormonal
NCI vs SCI
↑ 12 hour urinary cortisol levels in SCI subjects
Wolf, et al., Neurobiol Aging, 2005; 26:1357-1363.
Brain Changes: Function Neurometabolism
NCI vs SCI
↓ metabolism:
parahippocampal gyrus
(bilaterally 18% reduction)
middle temporal gyrus
inferior parietal lobe
inferior frontal gyrus
fusiform gyrus
thalamus
right putamen
Mosconi, et al., Biological Psychiatry, 63: 609-18, 2008.
P<0.05 FWE correctedMosconi e al, Biol Psych 2008: 63:609-18.
Subjective Cognitive Impairment Hypometabolism in SCI, Mosconi, et al. Biological Psychiatry, 2008
middle-age NL with SCI (n=13) vs NCI (n=15)
n=15n=13
Prevalence of CSF Markers of AD Pathology:* Percentage of Subjects with an AD Type CSF profilea
aThe CSF AD profile was defined as a score < 1 calculated with the formula:
Aβ42/(240+[1.18 x T-tau])
*Visser, Verhey, Knol, et al., Prevalence and prognostic value of CSF markers of Alzheimer's disease pathology in patients with subjective cognitive impairment or mild cognitive impairment in the DESCRIPA
study: a prospective cohort study, Lancet Neurology, 8, 619-627, 2009.
SCI vs NCIPrognostic Group Differences
Prediction of Dementia: Other Studies
St. John and Montgomery
International Journal of Geriatric Psychiatry, 2002.
After adjusting for age, gender, and depressive symptoms
→ SCI predicted dementia
15% developed dementia in 5 yrs.
After adjusting for mental status assessment scores,
→ SCI did not predict
dementia
SCI vs NCIPrognostic Group Differences
Prediction of Dementia: Negative Studies
Wang, et al., Journal of the American Geriatrics Society, 2000 3 yr study All persons ≥ 65 in a Chinese rural population
→ Subjective complaints subjects had ↓ cognitive performance at baseline
→ Subjective memory complaints did not predict faster cognitive decline or dementia
Subjects
Consecutive series
Healthy subjects, GDS stage 1 or 2
≥ 40 years of age
Presenting to the NYU ADRC
between 1-1-1984 and 12-31-1997
(14 year window)
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
N = 260
NCI (GDS stage 1) n = 60
SCI (GDS stage 2) n = 200
Subjects were scheduled for F/U at ~ 2 yr intervals
Analysis cut off date: 12-31-2001
(18 years after the baseline)
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
Outcome:
Stable: if subject remained normal and had not declined to MCI or dementia over the
F/U observation period
Decline: if the subject declined to MCI or dementia; the first observation period of decline
was
used for time to decline Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
Results
Follow-up was completed in 213 subjects (81.9%)
Lost to follow-up:
NCI n = 13 SCI n = 34 N.S. stage, age or MMSE; Education, p = .02; Gender, more men lost to F/U, p = 0.05
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
Characteristics of Subjects Followed
NCI SCI (GDS Stage 1) (GDS Stage 2)
n = 47 n = 166
Age 64 68*MMSE 29.6 29.0***Hamilton 3.1 4.4*
* p < 0.05, *** p < 0.001Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
Characteristics of Subjects Followed
No significant difference at baseline in:
Gender: Majority > 60% female
Education: Mean: 16 years
Any psychometric test or PDS
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
NCI SCI
(GDS Stage 1) (GDS Stage 2)
Time in study: 6.7 yrs 6.8 yrs
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
Outcome
NCI SCI (GDS Stage 1) (GDS Stage 2) n=47 n=166
Progressed Stable % Progressed Stable % 7 40 15% 90 76
54%****
Differences between the groups in outcome were significant P < 0.0001 Fisher’s exact testReisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and
without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
Mean Time to Decline
NCI SCI (GDS Stage 1) (GDS Stage 2) 8.8 years 5.3 years
Savage two sample test for event time, p = 0.0003
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
Survival AnalysisWeibull Proportional Hazards Model
Controlling for: Age Gender Education Level Follow-up time
The hazard ratio of SCI subjects 4.5 times the risk of decline
as NCI subjects
(95% Confidence limits, 1.9 to 10.3)Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
Survival Analysis: Kaplan-Meier Method
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
Conclusion
SCI is a condition in which:
(1) Persons score in the normal range on tests, but complain of impairment
(2) SCI persons have a ~ 4.5 x greater risk of decline to MCI or dementia than same gender, similarly aged and educated, non-SCI persons
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
Conclusions Continued
SCI is a condition in which:
(1) Persons declined more rapidly at 60% of the rate of NCI persons
(2) SCI persons declined sooner Mean decline time was 3.5 years longer for NCI
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
Accelerated Failure Time Model Analysis
Controlling for:
Baseline group
Age
Gender
Education level
Follow-up time
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
Baseline variables contributing significantly to the
time to decline:
MMSE p=0.05
BCRS (I-V) Total Score p<0.01
BCRS Axis 1
(Concentration &
Calculation) p<0.01
BCRS Axis 5
(Functioning) p<0.05
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
Baseline variables contributing significantly to the
time to decline:
Hamilton - Item 8 p<0.05(Slowness of thought and speech
and/or impaired concentration &
decreased motor activity)
Hamilton - Item 11
Somatic Anxiety p<0.01
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
Baseline variables contributing significantly to the
time to decline:
Psychometric Deterioration Score
(Composite of 9 tests) p<0.0001
Seven of 9 individual test variables p<0.05
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without
subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
SCI Subject Group
Baseline Variables Showing Significant Differences Between Stable and Decline Groups at Follow-up
Stable (n=76) Decline (n=90) P
Age 65.3 69.4 < 0.01
Education 16.2 15.1 < 0.01
MMSE 29.3 28.7 < 0.01
BCRS, Total score 8.5 9.3 < 0.01
BCRS Axis 1: Concentration and Calculation
2.0 2.4 < 0.001
BCRS Axis 5: Functioning
1.65 1.88 < 0.01
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
SCI Subject Group
Baseline Variables Showing Significant Difference Between Stable and Decline Groups at Follow-up
Behavior
Stable (n=76) Decline (n=90)
P
Hamilton – Item 10 (Tension, worry)
< 0.05
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
SCI Subject Group
Baseline Variables Showing Significant Difference Between Stable and Decline Groups at Follow-up
Behavior
Stable (n=76) Decline (n=90)
P
Hamilton – Item 10 (Tension, worry)
< 0.05
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
SCI Subject GroupBaseline Variables Showing Significant Differences Between
Stable and Decline Groups at Follow-up
Psychometric
Stable (n=76) Decline (n=90) PPsychometric Deterioration Score (PDS)
1.75 2.56 < 0.001
Paired Associates, Initial recall
5.22 4.17 < 0.01
Paired Associates, Delayed recall
5.66 4.47 < 0.01
Digit Span Forwards 7.26 6.58 < 0.001
Digit Span Reverse 5.86 5.12 0.001
DSST 54.6 48.8 < 0.01
WAIS Vocabulary 70.5 62.9 < 0.001
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
Conclusion
SCI is a condition in which:
(1) Persons score in the normal range on tests, but complain of impairment
(2) SCI persons have a ~ 4.5 x greater risk of decline to MCI or dementia than same gender, similarly aged and educated, non-SCI persons
(3) Is accompanied by cognitive losses which are evident in aggregate but not in individual cases
Reisberg, Shulman, Torossian et al., Outcome over seven years of healthy adults with and without subjective cognitive impairment, Alzheimer’s & Dementia, 6; 11-24, 2010.
Implications
for
AD Prevention
and
ADI Prevention Workgroup
We are now in a position to address
the prevention of AD
in persons with complaints
beginning >20 years
before dementia develops
Using some of the same measures
and kinds of measures
For example
MMSE,
BCRS, FAST
Psychometric measurements
as have been used in current medication approvals
for mild to severe AD
by worldwide regulatory agencies
78 y/o, MMSE = 26, 2009
JUNE 27, 2005
Agenda 3:00 PM Introduction to Workshop Barry Reisberg, M.D.
3:05 PM Cognitive dynamics: how variability in brain Kenneth Rockwood M.D., FRCPC, FRCPfunction influences the risk of cognitive decline
3:35 PM Current Knowledge of Methodologies for Barry Reisberg, M.D.Clinical Trials in Pre-MCI Persons with SubjectiveCognitive Impairment (SCI)
4:25 PM Discussion of Current Knowledge and Joel Sadavoy M.D., FRCPCMethodologies
4:35 PM Discussion of Clinical Instrumentation for Barry Reisberg, M.D.Subject Selection and Assessment
4:55 PM Subject Interview Workshop Faculty and Participants
5:25 PM Final Discussion Joel Sadavoy M.D., FRCPC