Family Detect Early Dementia Better than Clinical Exams

Family members and close friends are more sensitive to the first signs of Alzheimer's disease than traditional screening tests and can be used to help doctors make their diagnosis and start treatment sooner, researchers report.

Doctors often evaluate a person who is having memory problems by testing them with a variety of cognitive tasks, such as recalling a list of words or comparing shapes of objects. However, researchers at the Washington University School of Medicine in St. Louis developed a different approach. Their two-minute Ascertain Dementia 8 (AD8) questionnaire relies on a friend or family member who knows the person well, known as an informant, to evaluate whether cognitive changes have caused the individual to have difficulties in performing everyday activities.

In the new study, published online in the journal Brain, scientists validated the AD8 by checking to see if it could highlight individuals who had biological indicators, or biomarkers, for Alzheimer's disease, such as abnormal levels of certain factors in the spinal fluid or positive brain scans for Alzheimer's plaques. The AD8's results corresponded with biomarker results more consistently than traditional cognitive tests.

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According to Morris, the difficulty with traditional early-stage dementia screening tools is that they only give a snapshot of a person's cognitive abilities at one point in time -- when they're being tested. Asking the individual if his or her mental abilities have changed doesn't necessarily produce accurate results either, Morris says, because people with early-stage dementia often lack insight into their problem.

Researchers at the Knight Alzheimer's Disease Research Center developed the AD8 from the Center’s existing research tools. Informants are asked to rate whether there has been a change in the following areas:

* Problems with judgment, such as bad financial decisions;
* Reduced interest in hobbies and other activities;
* Repeating of questions, stories or statements;
* Trouble learning how to use a tool or appliance, such as a television remote control or a microwave;
* Forgetting the month or year;
* Difficulty handling complicated financial affairs, such as balancing a checkbook;
* Difficulty remembering appointments; and
* Consistent problems with thinking and memory.

Informants can respond yes or no to each item; each "yes" response is worth a point, and a score of two or more indicates a need for additional evaluation.

According to Morris, informants who have regular exposure to the individual provide the most accurate assessments.

"These informants can give us the perspective we need to know that a person's mental abilities have begun to meaningfully decline, indicating that additional testing is needed," Morris says.

For the new study, researchers gathered AD8 evaluations on 251 individuals and also tested them using the Mini Mental State exam, a traditional dementia screening test. They then evaluated biomarkers in the individuals, including spinal fluid assays and brain plaque scans.

"Based on our results, the AD8 appears to be superior to conventional testing in its ability to detect signs of early dementia," Morris says. "It can't tell us whether the dementia is caused by Alzheimer's or other disorders, but it lets us know when there's a need for more extensive evaluations to answer that question."

Since its development, the AD8 has been translated into several different languages and validated in those languages. It is currently in use in clinics around the world.

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