Normative data were collected in a study population of 150 randomly selected elderly subjects. Using the SIDAM (Structured Interview for the Diagnosis of Dementia of the Alzheimer Type, multi-infarct dementia, and dementias of other etiology according to DSM-III-R and ICD-10), both the dimensional and the categorical aspects of dementia and "mild cognitive impairment" are considered. With the SIDAM score (SISCO) [range 0 (minimum)-55 (maximum, no cognitive impairment)] and the SIDAM Mini-Mental State Examination (MMSE) (range 0-30), appropriate cutoffs for the category of DSM-III-R and ICD-10 dementia and "mild cognitive impairment" were defined. MMSE scores of 0-22 were found to be indicative of DSM-III-R and ICD-10 dementia. For "mild cognitive impairment," MMSE scores ranged from 23-27 according to a DSM-III-R definition (ICD-10: 23-28). An MMSE score of 22 or less was found to differentiate between DSM-III-R/ICD-10 dementia and "mild cognitive impairment," with a specificity of 92% (ICD-10: 95.6) and a sensitivity of 96% (ICD-10: 96%). With the SIDAM-based DSM-III-R/ICD-10 diagnoses of dementia as the criterion, the SISCO was 97.3% specific (ICD-10: 99%) and 94% sensitive (ICD-10: 94%) in detecting dementia. A SISCO of 0-33 was highly indicative of DSM-III-R and ICD-10 dementia. For "mild cognitive impairment," a SISCO between 34-47 (ICD-10: 34-51) was found. The SISCO covers a broader range of cognitive functions than the MMSE and is more useful in detecting even very mild cognitive decline. Furthermore, the newly defined category of "mild cognitive impairment" could be validated successfully by means of GDS Stages 2-3 and CDR Stage 0.5. These findings confirm the value of the SIDAM as a short diagnostic instrument for measurement and diagnosis of dementia and "mild cognitive impairment."

A new systematic method of measurement and diagnosis of "mild cognitive impairment" and dementia according to ICD-10 and DSM-III-R criteria

Supervisory Committee Dr. Holly A. Tuokko, Department of Psychology Supervisor Dr. Catherine A. Mateer, Department of Psychology Departmental Member Dr. Andre Smith, Department of Sociology Outside Member Dr. Jens Weber-Jahnke, Department of Computer Science Outside Member The absence of gold standard criteria for mild cognitive impairment (MCI) impedes the comparison of research findings and the development of primary and secondary prevention strategies addressing the possible conversion to dementia. The objective of Study 1 was to compare the predictive ability of different MCI models as markers for incipient dementia in a longitudinal population-based Canadian sample. The utility of well-documented MCI criteria using data from persons who underwent a clinical examination in the second wave of the Canadian Study of Health and Aging (CSHA) was examined. Demographic characteristics, average neuropsychological test performance, and prevalence and conversion rates were calculated for each classification. Receiver operating characteristic (ROC) analyses were employed to assess the predictive power of each cognitive classification. The highest prevalence and conversion rates were associated with case definitions of multiple-domain MCI. The only diagnostic criteria to significantly predict dementia five years later was the Cognitive Impairment, No Dementia (CIND) Type 2 case definition. It is estimated that more restrictive MCI case definitions fail to address the varying temporal increases in decline across different iv cognitive domains in the progression from normal cognitive functioning to dementia. Using data from the CSHA, the objective of Study 2 was to elucidate the clinical correlates that best differentiate between cognitive classifications. A machine learning algorithm was used to identify the symptoms that best discriminated between: 1) not cognitively impaired (NCI) and CIND; 2) CIND & demented; and 3) converting and nonconverting CIND participants. Poor retrieval was consistently a significant predictor of greater cognitive impairment across all three questions. While interactions with other predictors were noted when differentiating CIND from NCI and demented from nondemented participants, retrieval was the sole predictor of conversion to dementia over five years. Importantly, the limited specificity and predictive values of the respective algorithms caution against their use as clinical markers of CIND, dementia, or conversion. Rather, it is recommended that the predictors serve as markers for ongoing monitoring and assessment. Overall, the results of both studies suggest that the architecture of pathological cognitive decline to dementia may not be captured by a single set of diagnostic criteria.

Identifying mild cognitive impairment in older adults

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Identifying mild cognitive impairment in older adults