			Home About us Contact

Memory Clinic (memory + clinic)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Prevalence and cognitive impact of cerebrovascular findings in Alzheimer's disease: a retrospective, naturalistic study

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2009
N. Tabet
Summary Aims:, Cerebrovascular disease (CVD) is a major risk factor for cognitive decline associated with progression to Alzheimer's disease (AD) and dementia. The objective of this study was to retrospectively assess the prevalence of CVD and its cognitive impact in patients with AD in everyday clinical practice. Methods:, Medical notes were retrospectively reviewed for all individuals who presented at East Sussex Memory Clinic (2004,2008) for investigation of cognitive impairment and had brain magnetic resonance imaging (MRI) as part of their clinical work-up. Global cognitive status was assessed with Mini-Mental State Examination (MMSE) and Cambridge Cognitive Examination. The extent of cerebrovascular abnormalities was qualitatively evaluated with MRI. Results:, Notes were reviewed for 232 patients (109 males, 123 females), mean age 76 years (range 62,93), who underwent MRI. Of these, 167 (72%) patients were diagnosed with AD. CVD was present in 89% of AD patients and 47% of patients had moderate to severe cerebrovascular abnormalities. The majority of patients (57%) had MMSE scores in the 21,26 range, indicative of mild AD. There was a trend towards worse cognitive status in patients with more severe CVD, which did not reach significance. Hachinski Ischaemic score indicated these patients did not have vascular dementia (VaD) (mean ± standard deviation 1.1 ± 1.3). Conclusion:, These findings, based on qualitative MRI, indicate that cerebrovascular pathology is a very common associated feature in patients with mild to moderate AD, without VaD. Although the study suggests that CVD does not contribute to cognitive decline, and is not associated with the development of VaD, a non-significant trend was observed towards worsening cognitive status with increasing severity of CVD. The finding of this trend suggests a need for additional research, especially a prospective quantitative method of assessing CVD, to improve our understanding of how CVD contributes to cognitive impairment in AD. [source]

Association between cognition and daily life functioning in dementia subtypes

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2009
Sharon F. M. Bouwens
Abstract Objective To investigate the association between cognition and daily life functioning in dementia subtypes. Methods Cross-sectional data were used from 615 patients with dementia who were referred to the Maastricht Memory Clinic of the Maastricht University Medical Centre. Pearson correlation coefficients were calculated between the Mini-Mental State Examination (MMSE; to measure cognitive status) and the Blessed Dementia Scale (BDS; to measure daily life functioning) for the following types of dementia: Alzheimer's Disease (AD, n,=,442); Vascular dementia (VaD, n,=,113); frontotemporal dementia (FTD, n,=,18); Parkinson's dementia (PD, n,=,21); and primary progressive aphasia (PPA, n,=,21). One-way ANOVA was used to test differences in age, MMSE scores and BDS scores across dementia subtypes. Results Scores on the MMSE showed strong correlation with BDS scores in cases of FTD (r,=,,0.80); moderate correlation in cases of AD, VaD, and PD (range r,=,,0.50,0.60); while no correlation was found in PPA cases. Conclusions The association between cognition and daily life functioning varied among dementia subtypes for AD, VaD, FTD and PD. Furthermore, the overall scores on both domains differ between dementia subtypes, indicating that different types of dementia are characterized by a specific pattern of cognitive status and daily life functioning. These findings underline the need for multidomain assessment in patients with dementia. Copyright © 2009 John Wiley & Sons, Ltd. [source]

The significance of dyslexia screening for the assessment of dementia in older people

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2008
Claudia Metzler-Baddeley
Abstract Dyslexia and Dementia are disorders that share cognitive impairments in attention, language, and working memory. It is therefore possible that the presence of dyslexia may influence the assessment of the severity of dementia and potentially lead to the development of atypical forms of dementia. The present study investigated the prevalence of problems suggestive of dyslexia with a brief self-report questionnaire in a sample of 195 older adults referred to a Memory Clinic for dementia assessment. Ten percent reported problems suggestive of dyslexia consistent with the estimated prevalence in the general population. This group performed significantly lower in a number of attention and language related tests but not in other cognitive domains. These results highlight the importance of dyslexia screening for the assessment of dementia, not least because the choice of treatment is guided by the outcome of the assessment of the severity and the type of dementia. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Delusion symptoms are associated with ApoE ,4 allelic variant at the early stage of Alzheimer's disease with late onset

EUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2006
G. Spalletta
Alzheimer's disease (AD) is a neurodegenerative disorder with mixed cognitive and behavioural clinical manifestations. The possession of apolipoprotein-E (ApoE) ,4 allelic variant is one of the most important risk factors for developing late-onset AD (LOAD). In this study we analysed the relationship between the entire range of behavioural symptoms, cognitive deficit, and sociodemographic characteristics and ApoE ,4 allele possession with multivariate logistic regression models in LOAD patients. Patients included (n = 171) were consecutively admitted in a memory clinic for the first diagnostic visit. Levels of behaviour and cognition within the last month were assessed by the Neuropsychiatric Inventory and Mini Mental State Examination. Presence of clinically significant psychosis, delusions and hallucinations at the early stage of the illness, from the onset to the first visit, was measured with diagnostic criteria. ApoE ,4 allele possession was associated with increased levels of delusions within the last month from the first visit (OR 1.23; 95% CI 1.01,1.50; P < 0.05) and with the presence of categorical delusions at the early stage until the first visit (OR 3.11; 95% CI 1.21,8.01; P < 0.02). In this study, which considers the entire range of behavioural expressions in LOAD patients at the early stage of the illness, the relationship between behaviour and ApoE ,4 allele is confirmed for delusions only. [source]

Brief screening tool for mild cognitive impairment in older Japanese: Validation of the Japanese version of the Montreal Cognitive Assessment

GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2010
Yoshinori Fujiwara
Aim: The Montreal Cognitive Assessment (MoCA), developed by Dr Nasreddine (Nasreddine et al. 2005), is a brief cognitive screening tool for detecting older people with mild cognitive impairment (MCI). We examined the reliability and validity of the Japanese version of the MoCA (MoCA-J) in older Japanese subjects. Methods: Subjects were recruited from the outpatient memory clinic of Tokyo Metropolitan Geriatric Hospital or community-based medical health check-ups in 2008. The MoCA-J, the Mini-Mental State Examination (MMSE), the revised version of Hasegawa's Dementia Scale (HDS-R), Clinical Dementia Rating (CDR) scale, and routine neuropsychological batteries were conducted on 96 older subjects. Mild Alzheimer's disease (AD) was found in 30 subjects and MCI in 30, with 36 normal controls. Results: The Cronbach's alpha of MoCA-J as an index of internal consistency was 0.74. The test,retest reliability of MoCA, using intraclass correlation coefficient between the scores at baseline survey and follow-up survey 8 weeks later was 0.88 (P < 0.001). MoCA-J score was highly correlated with MMSE (r = 0.83, P < 0.001), HDS-R (r = 0.79, P < 0.001) and CDR (r = ,0.79, P < 0.001) scores. The areas under receiver,operator curves (AUC) for predicting MCI and AD groups by the MoCA-J were 0.95 (95% confidence interval [CI] = 0.90,1.00) and 0.99 (95% CI = 0.00,1.00), respectively. The corresponding values for MMSE and HDS-R were 0.85 (95% CI = 0.75,0.95) and 0.97 (95% CI = 0.00,1.00), and 0.86 (95% CI = 0.76,0.95) and 0.97 (95% CI = 0.00,1.00), respectively. Using a cut-off point of 25/26, the MoCA-J demonstrated a sensitivity of 93.0% and a specificity of 87.0% in screening MCI. Conclusion: The MoCA-J could be a useful cognitive test for screening MCI, and could be recommended in a primary clinical setting and for geriatric health screening in the community. Geriatr Gerontol Int 2010; 10: 225,232. [source]

Is there any role for computed tomography measurements of medial temporal lobe atrophy in dementia?

INTERNAL MEDICINE JOURNAL, Issue 2 2008
A review of the literature, case series from a memory clinic
Abstract Neuroimaging in dementia has focused on documenting any burden of vascular disease or excluding any reversible intracranial pathology. We review the use of computed tomography to examine for medial temporal lobe atrophy in dementia and compare this with a case series of such measurements from our memory clinic. Measures of medial temporal lobe atrophy were used to separate patients with Alzheimer's disease from those with normal cognition, mood disorders or other forms of early dementia. [source]

Impact of cerebrovascular pathology on behavioural and neuropsychiatric symptoms in patients with Alzheimer's dementia: findings from a retrospective, naturalistic study

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2009
A. Klugman
Summary Aim:, Cerebrovascular disease (CVD) has been associated with depression and a host of neuropsychiatric conditions including dementia. This study assessed the relationship between cerebrovascular findings reported on MRI brain scans and neuropsychiatric symptoms (NPS) and behavioural problems in patients with Alzheimer's disease (AD). Methods:, Medical notes were retrospectively reviewed in patients undergoing brain MRI following referral for cognitive impairment to a memory clinic between January 2004 and June 2008. Patients with AD were graded into four categories of CVD severity based on neuroradiology reports and assessed for behavioural and NPS and activities of daily living using Neuropsychiatric Inventory (NPI), Geriatric Depression Scale (GDS) and Bristol Activities of Daily Living (BADL). Frontal lobe symptoms and parkinsonian features were also evaluated. Results:, Of the initial 232 patients who underwent MRI 72% were diagnosed with AD. 89% of AD patients had CVD findings reported on MRI. Moderate-to-severe CVD was present in 47% of patients. None of the AD patients satisfied a diagnosis of vascular dementia. There was no significant relationship observed between level of MRI CVD findings and scores on NPI (p = 0.57), GDS (p = 0.26) and BADL (p = 0.46). The level of CVD severity did not appear to influence frontal lobe and parkinsonian assessments (p = 0.60). Conclusion:, The contribution of CVD to the pathogenesis of various NPS is still debated. Our study, based on patients diagnosed with AD in a memory clinic setting, suggests that there is no relationship between the extent of CVD pathology and neuropsychiatric and behavioural measures in AD patients. Further prospective quantitative studies are needed to assess the role of CVD, if any, in neuropsychiatric and behavioural symptoms in AD. It is possible that the relatively small pathological contribution of CVD to the development of these symptoms is obscured by the effect of the wider neurodegeneration encountered in AD. [source]

Executive functioning in Alzheimer's disease and vascular dementia,

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2010
B. McGuinness
Abstract Objective To compare performance of patients with mild-moderate Alzheimer's disease (AD) and vascular dementia (VaD) on tests of executive functioning and working memory. Methods Patients with AD (n,=,76) and VaD (n,=,46) were recruited from a memory clinic along with dementia free participants (n,=,28). They underwent specific tests of working memory from the Cognitive Drug Research (CDR) battery and pen and paper tests of executive function including CLOX 1 & 2, EXIT25 and a test of verbal fluency (COWAT). All patients had a CT brain scan which was independently scored for white matter change/ischaemia. Results The AD and VaD groups were significantly impaired on all measures of working memory and executive functioning compared to the disease free group. There were no significant differences between the AD and VaD groups on any measure. Z- scores confirmed the pattern of impairment in executive functioning and working memory was largely equivalent in both patient groups. Small to moderate correlations were seen between the MMSE and the neurocognitive scores in both patient groups and the pattern of correlations was also very similar in both patient groups. Conclusions This study demonstrates sizeable executive functioning and working memory impairments in patients with mild-moderate AD and VaD but no significant differences between the disease groups. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Stress affects carers before patient's first visit to a memory clinic

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2009
Tor Atle Rosness
Abstract Objective To measure and compare the burden on spousal carers of patients with and without dementia who were consulting a memory clinic for the first time. Methods We included 413 dyads of patients and their spousal carers consulting a memory clinic for the first time. Of them 276 had a diagnosis of Cognitive Impairment No Dementia (CIND) and 137 had a dementia diagnosis. The burden of care was measured with the Relative Stress Scale (RSS). The gender of patients and their spouses was recorded and measures of cognition, depression and functional capacity of the patients were included in the analysis. Results Of all carers, 27.6% had a score on the RSS of above 23, indicating a moderate to severe burden. The corresponding score for carers of patients with CIND was 20.3%, compared to 42.2% for those with dementia. However, in a linear regression analysis with RSS as the dependent variable, the dementia diagnosis variable was not significant. Three variables were significant (p,<,0.05) and has explained 34% of the variance of the score on the RSS, impaired function in activities of daily living (ADL) was the most important variable (, 0.56), followed by female gender of carers (, 0.19) and the extent of the symptoms of depression observed in the patients (, 0.10). Conclusion Carers of both CIND and dementia patients when attending a memory clinic for initial diagnostic assessment experience high levels of stress. Impaired function in ADL in patients is the strongest predictor of this stress. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Diagnoses and vascular risk factors in a cohort of 150 attendees at a memory clinic

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2006
Jey Selwyn
No abstract is available for this article. [source]

Neuropsychological performance in early and late onset Alzheimer's disease: comparisons in a memory clinic population

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2004
Srinivas Suribhatla
Abstract Objectives To compare the neuropsychological performance associated with early and late onset Alzheimer's disease (AD), in order to identify differences and compare these with previous reports. Methods Patients attending a memory clinic were given a detailed multi-disciplinary diagnostic assessment, including a battery of neuropsychological tests. From those meeting ICD-10 criteria for Alzheimer's disease (AD), an early-onset (EO) group (n,=,40) and a late-onset (LO) group (n,=,90) were identified, and their performances compared. Patients with mixed dementia and co-morbid depression were excluded. Results After adjustment, the EO and LO groups performed at a comparable level on the majority of the neuropsychological tests. The LO group performed better on the WAIS digit span test, AMIPB Complex Design and the written picture description, and the EO group performed better on the WAIS similarities test and the Boston naming test. Conclusions These findings suggest that, after adjusting for overall dementia severity and pre-morbid IQ, there is greater fronto-parietal/right hemisphere involvement in early-onset AD, and greater temporal/left hemisphere involvement in late-onset AD. This may be due to different genetic risk profiles for AD at different ages. Copyright © 2004 John Wiley & Sons, Ltd. [source]

Measuring the opinions of memory clinic users: patients, relatives and general practitioners

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2001
H. P. J. van Hout
Abstract Background The opinions of memory clinic users are important to assess the value of memory clinics. Objective To measure the quality of care of an outpatient memory clinic for the elderly as perceived by patients, their relatives and general practitioners (GPs). Methods An observational study was conducted to measure the opinions of the users of a typical outpatient memory clinic. Opinions on five aspects were measured: (1) communication of the results, (2) provision of diagnostic information, (3) attitude of the clinicians, (4) usefulness of the medical assessment, and (5) information and advice to relatives. Patients and relatives were both interviewed with a dementia care satisfaction questionnaire. The GPs' opinions were derived with a self-constructed questionnaire. Results On 105 consecutive assessments, 101 opinions of GPs, 81 of caregivers and 31 of patients were recorded. Positive opinions were recorded on the way the results were communicated, the usefulness of the assessment and attitude of the clinicians. In contrast to GPs and relatives, patients were less positive about the clarity of the diagnostic information received. Both relatives and GPs were negative on information and advice to relatives. Conclusions Patients, caregivers and GPs had positive opinions about the diagnostic value of the memory clinic. Quality improvement could focus on the clarity of the diagnostic information for patients and on better advice to relatives. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Verbal aggression in Alzheimer's disease.

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2001
Clinical, functional, neuropsychological correlates
Abstract Objectives To determine the clinical, functional and neuropsychological correlates of verbal aggression in Alzheimer's disease in a group of consecutive first attendees to a memory clinic. Methods 150 people were evaluated and diagnosed as suffering with probable Alzheimer's disease. These people were tested using the Behave-AD for the presence of verbal aggression, delusions, depression and agitation. They were also assessed with cognitive, functional and neuropsychological scales. Results Twenty-eight per cent of this group of Alzheimer patients had exhibited some verbal aggression in the preceding month. Male gender (p,=,0.022), the presence of paranoid and delusional ideation (p,=,0.003) and agitation (p,=,0.042) were significantly associated with verbal aggression in a stepwise backward logistic regression analysis. Conclusion The presence of verbal aggression should prompt the clinician to search for delusional ideation, which may respond to phamacotherapy. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Three sides of the same coin: measuring global cognitive impairment with the MMSE, ADAS-cog and CAMCOG

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2010
Hans Wouters
Abstract Objective The total scores of the ADAS-cog, MMSE and CAMCOG, comprising various cognitive tasks, are widely used to measure a dimension of global cognitive impairment. It is unknown, however, whether this dimension is common to these instruments. This hampers comparisons when either of these instruments is used. The extent to which these instruments share a common dimension of global cognitive impairment and how their scores relate was examined. Methods Rasch analysis of CAMCOG and MMSE data of participants from a population based study and two memory clinics pooled with ADAS-cog and MMSE data of participants from three RCTs (overall N,=,1566) to estimate a common dimension of global cognitive impairment and to examine the goodness of fit of the individual items to this dimension. Results Using the estimated common dimension of global cognitive impairment, the total scores of the instruments could be related, e.g. a mean level of global cognitive impairment corresponded to a predicted score of 11.4 (ADAS-cog), 72.6 (CAMCOG) and 22.2 (MMSE). When revised according to The Rasch validity analyses, every individual item could be fitted to the dimension. Conclusions The MMSE, ADAS-cog and CAMCOG reflect a valid common dimension of global cognitive impairment, which enables comparisons of RCTs that use the ADAS-cog and observational studies that use the CAMCOG and MMSE. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Screening for mild cognitive impairment: a systematic review

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2009
Jane A. Lonie
Abstract Objective Patients with mild cognitive impairment account for a significant number of referrals to old age psychiatry services and specialist memory clinics. The cognitive evaluation of such patients is commonly restricted to brief dementia screens, with no consideration to their suitability for assessing MCI. Here, we review the utility of such cognitive screens for MCI and provide an overview of validated instruments. Methods We identified papers published after Petersen and colleagues 1999 MCI criteria (Petersen et al., 1999) and examining face-to-face cognitive screening for MCI from publication databases using combinations of the search terms ,mild cognitive impairment' and ,cognitive screening'. We also combined the former search with the names of 39 screening tests recently identified in a relevant review (Cullen et al., 2007). Results Fifteen cognitive screening instruments were identified, 11 cover a restricted range of cognitive domains. High sensitivity and specificity for MCI relative to healthy controls were reported for two comprehensive and two noncomprehensive screening instruments, adequate test-retest and inter-rater reliability for only one of these. With the exception of three studies, sample sizes were universally small (i.e. n,,,100), and prognostic values were reported for only two of the identified 15 screening measures. Sensitivities of the full domain measures were universally high, but information about their specificity against psychiatric and non-progressive neurological conditions and predictive validity is lacking. Conclusion Several cognitive screening instruments afford the clinician the ability to detect MCI, early AD, and in some cases non-AD dementia, but they cannot currently be used to make reliable inferences about the course and eventual outcome of MCI. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Multidisciplinary memory clinics: what is important to caregivers and clients?

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2004
Peter Foreman
No abstract is available for this article. [source]