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01-10-2010 | Original Communication

Reduced benefit from mnemonic strategies in early-stage Alzheimer’s disease: a brief testing-the-limits paradigm for clinical practice

Authors: Ingo Uttner, Niklas Schurig, Christine A. F. von Arnim, Christian Lange-Asschenfeldt, Hayrettin Tumani, Matthias W. Riepe

Published in: Journal of Neurology | Issue 10/2010

Abstract

Discriminating incipient Alzheimer’s disease (AD) from major depression (MD) and age related memory decline is a challenge in clinical practice. Since AD is characterized by an early loss of neuronal and functional plasticity, a dynamic test strategy, such as the testing-the-limits (TtL) approach, that measures learning capacity can be a helpful diagnostic tool. To evaluate this, a short recognition paradigm consisting of a pre-test (baseline) and two post-test conditions with an interposed encoding instruction was developed and administered to individuals with incipient AD (n = 19; Mini Mental Status Examination (MMSE) 26.5), patients with depressive disorders (n = 11; MMSE 30), and healthy controls (n = 11; MMSE 30). In addition, participants completed a set of traditional neuropsychological tests that focused on the subjects’ cognitive baseline performance. Intergroup comparisons (Kruskal–Wallis, U test) revealed significantly higher post-test failure rates in AD patients. Pre-test performance of MD and AD patients did not differ. Intra-group comparisons (Friedman, Wilcoxon test) showed that all three subject samples benefit from intervention in post-test 1. In contrast to MD and healthy individuals, who revealed significantly lower failure rates in post-test 2 compared to the pre-test, AD patients did not improve. Out of the 15 traditional test scores obtained, only two discriminated simultaneously between AD and each of the other groups. Our data confirm the finding of an impaired cognitive plasticity already present in very early stages of AD and illustrate the efficiency of a dynamic test approach in identifying incipient dementia.

American Psychiatric Association (1994) Diagnostic Criteria from DSM-IV. American Psychiatric Association, Washington, DC

Baltes MM, Kuhl KP, Sowarka D (1992) Testing for limits of cognitive reserve capacity: a promising strategy for early diagnosis of dementia? J Gerontol 47:165–167

Baltes MM, Kuhl KP, Gutzmann H, Sowarka D (1995) Potential of cognitive plasticity as a diagnostic instrument: a cross-validation and extension. Psychol Aging 10:167–172CrossRefPubMed

Baltes MM, Raykov T (1996) Prospective validity of cognitive plasticity in the diagnosis of mental status: a structural equitation model. Neuropsychology 10:549–556CrossRef

Baltes PB, Staudinger UM, Lindenberger U (1999) Lifespan psychology: theory and application to intellectual functioning. Annu Rev Psychol 50:471–507CrossRefPubMed

Bäckman L, Jones S, Berger AK, Laukka EJ, Small BJ (2005) Cognitive impairment in preclinical Alzheimer’s disease: a meta-analysis. Neuropsychology 19:520–531CrossRefPubMed

Beinhoff U, Hilbert V, Bittner D, Grön G, Riepe MW (2005) Screening for cognitive impairment: a triage for outpatient care. Dement Geriatr Cogn Disord 20:278–285CrossRefPubMed

Boustani M, Peterson B, Hanson L, Harris R, Lohr KN (2003) Screening for dementia in primary care: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 138:927–937PubMed

Braak H, Braak E (1996) Evolution of the neuropathology of Alzheimer’s disease. Acta Neurol Scand Suppl 165:3–12PubMed

10.

Brand AN, Jolles J, Gispen-de Wied C (1992) Recall and recognition memory deficits in depression. J Affect Disord 25:77–86CrossRefPubMed

11.

Buschke H, Kuslansky G, Katz M, Stewart WF, Sliwinski MJ, Eckholdt HM, Lipton RB (1999) Screening for dementia with the memory impairment screen. Neurology 52:231–238PubMed

12.

Calero MD, Navarro E (2004) Relationship between plasticity, mild cognitive impairment and cognitive decline. Arch Clin Neuropsychol 19:653–660CrossRefPubMed

13.

Calero MD, Navarro E (2007) Cognitive plasticity as a modulating variable on the effects of memory training in elderly persons. Arch Clin Neuropsychol 22:63–72CrossRefPubMed

14.

Chong MS, Sahadevan S (2005) Preclinical Alzheimer’s disease: diagnosis and prediction of progression. Lancet Neurol 4:576–579CrossRefPubMed

15.

Cohen RM, Weingartner H, Smallberg SA, Pickar D, Murphy DL (1982) Effort and cognition in depression. Arch Gen Psychiatry 39:593–597PubMed

16.

Colcombe SJ, Erickson KI, Scalf PE, Kim JS, Prakash R, McAuley E, Elavsky S, Marquez DX, Hu L, Kramer AF (2006) Aerobic exercise training increases brain volume in aging humans. J Gerontol A Biol Sci Med Sci 61:1166–1170PubMed

17.

Crane PK, Gibbons LE, Jolley L, van Belle G, Selleri R, Dalmonte E, De Ronchi D (2006) Differential item functioning related to education and age in the Italian version of the Mini-mental State Examination. Int Psychogeriatr 18:505–515CrossRefPubMed

18.

Dubois B, Feldman HH, Jacova C, Dekosky ST, Barberger-Gateau P, Cummings J, Delacourte A, Galasko D, Gauthier S, Jicha G, Meguro K, O’brien J, Pasquier F, Robert P, Rossor M, Salloway S, Stern Y, Visser PJ, Scheltens P (2007) Research criteria for the diagnosis of Alzheimer’s disease: revising the NINCDS-ADRDA criteria. Lancet Neurol 6:734–746CrossRefPubMed

19.

Elias MF, Beiser A, Wolf PA, Au R, White RF, D’Agostino RB (2000) The preclinical phase of Alzheimer disease: a 22-year prospective study of the Framingham Cohort. Arch Neurol 57:808–813CrossRefPubMed

20.

Ellis HC (1990) Depressive deficits in memory: processing initiative and resource allocation. J Exp Psychol Gen 119:60–62CrossRefPubMed

21.

Fernandez-Ballesteros R, Zamarron MD, Tarraga L (2005) Learning potential: a new method for assessing cognitive impairment. Int Psychogeriatr 17:119–128CrossRefPubMed

22.

Fischer P, Simanyi M, Danielczyk W (1990) Depression in dementia of the Alzheimer type and in multi-infarct dementia. Am J Psychiatry 147:1484–1487PubMed

23.

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 12:189–198CrossRefPubMed

24.

Grady CL (2008) Cognitive neuroscience of aging. Ann N Y Acad Sci 1124:127–144CrossRefPubMed

25.

Grafman J, Weingartner H, Lawlor B, Mellow AM, Thompsen-Putnam K, Sunderland T (1990) Automatic memory processes in patients with dementia-Alzheimer’s type (DAT). Cortex 26:361–371PubMed

26.

Grigoletto F, Zappala G, Anderson DW, Lebowitz BD (1999) Norms for the Mini-Mental State Examination in a healthy population. Neurology 53:315–320PubMed

27.

Hertel PT, Hardin TS (1990) Remembering with and without awareness in a depressed mood: evidence of deficits in initiative. J Exp Psychol Gen 119:45–59CrossRefPubMed

28.

Hodges JR, Erzinçlioğlu S, Patterson K (2006) Evolution of cognitive deficits and conversion to dementia in patients with mild cognitive impairment: a very-long-term follow-up study. Dement Geriatr Cogn Disord 21:380–391CrossRefPubMed

29.

Hyman BT, Van Hoesen GW, Damasio AR, Barnes CL (1984) Alzheimer’s disease: cell-specific pathology isolates the hippocampal formation. Science 225:1168–1170CrossRefPubMed

30.

Ilmberger J (1988) Deutsche Version des California Verbal Learning Tests. Institut für Medizinische Psychologie der Universität München, München

31.

Jones S, Nyberg L, Sandblom J, Stigsdotter-Neely A, Ingvar M, Magnus-Petersson K, Bäckman L (2006) Cognitive and neural plasticity in aging: general and task-specific limitations. Neurosci Biobehav Rev 30:864–871CrossRefPubMed

32.

Kaplan EF, Goodglass H, Weintraub S (1983) The Boston Naming Test, 2nd edn. Lea and Febiger, Philadelphia

33.

Kempermann G, Gast D, Gage FH (2002) Neuroplasticity in old age: sustained fivefold induction of hippocampal neurogenesis by long-term environmental enrichment. Ann Neurol 52:135–143CrossRefPubMed

34.

Kliegl R, Smith J, Baltes PB (1989) Testing-the-limits and the study of adult age differences in cognitive plasticity of a mnemonic skill. Dev Psychol 25:247–256CrossRef

35.

Lockhart RS, Craik FIM (1990) Levels of processing: a retrospective commentary on a framework for memory research. Can J Psychol 44:87–112

36.

Lopez OL, Kuller LH, Becker JT, Dulberg C, Sweet RA, Gach HM, Dekosky ST (2007) Incidence of dementia in mild cognitive impairment in the cardiovascular health study cognition study. Arch Neurol 64:416–420CrossRefPubMed

37.

Mahncke H, Condor BB, Appelman J, Ahsanuddin ON, Hardy JL, Wood RA, Joyce NM, Boniske T, Atkins SM, Merzenich MM (2006) Memory enhancement in healthy older adults using a brain plasticity-based training program: a randomized, controlled study. Proc Natl Acad Sci USA 103:12523–12528CrossRefPubMed

38.

Maioli F, Coveri M, Pagni P, Chiandetti C, Marchetti C, Ciarrocchi R, Ruggero C, Nativio V, Onesti A, D’Anastasio C, Pedone V (2007) Conversion of mild cognitive impairment to dementia in elderly subjects: a preliminary study in a memory and cognitive disorder unit. Arch Gerontol Geriatr Suppl 1(44):233–241CrossRef

39.

McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM (1984) Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 34:939–944PubMed

40.

Mojtabai R, Olfson M (2004) Major depression in community-dwelling middle-aged and older adults: prevalence and 2- and 4-year follow-up symptoms. Psychol Med 34:623–634CrossRefPubMed

41.

Mondadori CR, Buchmann A, Mustovic H, Schmidt CF, Boesiger P, Nitsch RM, Hock C, Streffer J, Henke K (2006) Enhanced brain activity may precede the diagnosis of Alzheimer’s disease by 30 years. Brain 129:2908–2922CrossRefPubMed

42.

Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G, Mellits ED, Clark C (1989) The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology 39:1159–1165PubMed

43.

Nilsson GL, Bäckman L, Herltz A, Karlsson T, Österlind PO, Winblad B (1987) Patterns of memory performance in young-old and old-old adults: a selective review. Compr Gerontol B 1:49–53PubMed

44.

Olin JT, Katz IR, Meyers BS, Schneider LS, Lebowitz BD (2002) Provisional diagnostic criteria for depression of Alzheimer disease: rationale and background. Am J Geriatr Psychiatry 10:129–141PubMed

45.

Paizanis E, Kelai S, Renoir T, Hamon M, Lanfumey L (2007) Life-long hippocampal neurogenesis: environmental, pharmacological and neurochemical modulations. Neurochem Res 32:1762–1771CrossRefPubMed

46.

Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E (1999) Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 56:303–308CrossRefPubMed

47.

Rabinowitz JC (1989) Age deficits in recall under optimal study conditions. Psychol Aging 4:378–380CrossRefPubMed

48.

Ravaglia G, Forti P, Maioli F, Martelli M, Servadei L, Brunetti N, Pantieri G, Mariani E (2006) Conversion of mild cognitive impairment to dementia: predictive role of mild cognitive impairment subtypes and vascular risk factors. Dement Geriatr Cogn Disord 21:51–58CrossRefPubMed

49.

Raykov T, Baltes MM, Neher KM, Sowarka D (2002) A comparative study of two psychometric approaches to detect risk status for dementia. Gerontology 48:185–193CrossRefPubMed

50.

Riege WH, Inman V (1981) Age differences in nonverbal memory tasks. J Gerontol 36:51–58PubMed

51.

Rohling ML, Ellis NR, Scogin F (1991) Automatic and effortful memory processes in elderly persons with organic brain pathology. J Gerontol 46:137–143

52.

Rosen WG, Moh RC, Davis KL (1984) A new rating scale for Alzheimer’s disease. Am J Psychiatry 141:1356–1366PubMed

53.

Roy-Byrne PP, Weingartner H, Bierer LM, Thompson K, Post RM (1986) Effortful and automatic cognitive processes in depression. Arch Gen Psychiatry 43:265–267PubMed

54.

Salthouse TA (1996) The processing speed theory of adult age differences in cognition. Psychol Rev 103:403–428CrossRefPubMed

55.

Schrijnemaekers AM, de Jager CA, Hogervorst E, Budge MM (2006) Cases with mild cognitive impairment and Alzheimer’s disease fail to benefit from repeated exposure to episodic memory tests as compared with controls. J Clin Exp Neuropsychol 28:438–455CrossRefPubMed

56.

Shankar GM, Li S, Mehta TH, Garcia-Munoz A, Shepardson NE, Smith I, Brett FM, Farrell MA, Rowan MJ, Lemere CA, Regan CM, Walsh DM, Sabatini BL, Selkoe DJ (2008) Amyloid-beta protein dimers isolated directly from Alzheimer’s brains impair synaptic plasticity and memory. Nat Med 14:837–842CrossRefPubMed

57.

Solfrizzi V, Panza F, Colacicco AM, D’Introno A, Capurso C, Torres F, Grigoletto F, Maggi S, Del Parigi A, Reiman EM, Caselli RJ, Scafato E, Farchi G, Capurso A (2004) Vascular risk factors, incidence of MCI, and rates of progression to dementia. Neurology 63:1882–1891PubMed

58.

Spinnler H, Della Sala S, Bandiera R, Baddeley A (1988) Dementia, ageing, and the structure of human memory. Cogn Neuropsychol 5:193–211CrossRef

59.

Sporer SL (1991) Deep–deeper–deepest? Encoding strategies and the recognition of human faces. J Exp Psychol Learn Mem Cogn 17:323–333CrossRefPubMed

60.

Starr JM, Lonie J (2007) The influence of pre-morbid IQ on Mini-Mental State Examination score at time of dementia presentation. Int J Geriatr Psychiatry 22:382–384CrossRefPubMed

61.

Stern Y (2002) What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc 8:448–460CrossRefPubMed

62.

Stern Y (2006) Cognitive reserve and Alzheimer disease. Alzheimer Dis Assoc Disord 20:112–117CrossRefPubMed

63.

Storey E, Kinsella GJ, Slavin MJ (2001) The neuropsychological diagnosis of Alzheimer’s disease. J Alzheimers Dis 3:261–285PubMed

64.

Shulman KI (2000) Clock-drawing: is it the ideal cognitive screening test? Int J Geriatr Psychiatry 15:548–561CrossRefPubMed

65.

Tian J, Bucks RS, Haworth J, Wilcock G (2003) Neuropsychological prediction of conversion to dementia from questionable dementia: statistically significant but not yet clinically useful. J Neurol Neurosurg Psychiatry 74:433–438CrossRefPubMed

66.

Watts FN, Dalgleish T, Bourke P, Healy D (1990) Memory deficit in clinical depression: processing resources and the structure of materials. Psychol Med 20:345–349CrossRefPubMed

67.

Weingartner H, Cohen RM, Bunney WE, Ebert MH, Kaye W (1982) Memory-learning impairments in progressive dementia and depression. Am J Psychiatry 139:135–136PubMed

68.

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 (2004) Mild cognitive impairment: beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 256:240–246CrossRefPubMed

69.

Zapotoczky HG (1998) Problems of differential diagnosis between depressive pseudodementia and Alzheimer’s disease. J Neural Transm Suppl 53:91–95PubMed

70.

Zimmermann P, Fimm B (1993) Testbatterie zur Aufmerksamkeitsprüfung. PSYTEST, Freiburg

Title: Reduced benefit from mnemonic strategies in early-stage Alzheimer’s disease: a brief testing-the-limits paradigm for clinical practice
Authors: Ingo Uttner
Niklas Schurig
Christine A. F. von Arnim
Christian Lange-Asschenfeldt
Hayrettin Tumani
Matthias W. Riepe
Publication date: 01-10-2010
Publisher: Springer-Verlag
Published in: Journal of Neurology / Issue 10/2010
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-010-5610-8

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Reduced benefit from mnemonic strategies in early-stage Alzheimer’s disease: a brief testing-the-limits paradigm for clinical practice

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