Mental Test Spots Alzheimer's Risk (HealthDay)

TUESDAY, July 1 (HealthDay News) -- A new questionnaire may helpin both diagnosing older adults facing dementia and also in identifyingindividuals who need help with daily living.

The Everyday Cognition instrument consists of 39 questions to beanswered by people who know the patient well.

"There have been a number of studies that show that people with mildcognitive impairment who have functional problems in addition toperforming poorly on neuropsychological testing are more likely toprogress in the near future," said study author Sarah Tomaszewski Farias,an assistant professor of neurology at the University of California,Davis, Medical Center in Sacramento. "One of our hopes is that thisinstrument will be able to help identify very early on those people atincreased risk for developing Alzheimer's disease."

That would help both patients and family members prepare for what liesahead and identify patients who need to be more closely monitored.

In addition, Farias said, the test would also help identify "people whoare having [functional] problems so that we know who needs help and whodoesn't."

"What's nice about this is that it is designed to pick up very earlymemory problems, and it's an entirely caregiver-based survey," said Dr.Scott Turner, incoming director of the Memory Disorders Program atGeorgetown University Medical Center, in Washington, D.C. "This issomething the caregiver can fill out, while the practitioner is looking atthe patient. It could be used for screening, for diagnosis and for drugdevelopment, if you want to look for some proof that your drug is havingsome effect, so it has a lot of potential uses."

"They want something that they could use to ask a family member aboutthe potential patient's everyday functioning to see if that's sensitive topicking up the likelihood of dementia early on," added Dr. Gary J.Kennedy, director of geriatric psychiatry at Montefiore Medical Center inNew York City.

The findings were published in the July issue ofNeuropsychology.

Existing neuropsychological tests tend to be very abstract. For thelast 40 years, these tests have looked at two categories: so-called"basic" activities (such as grooming, feeding, dressing), which areaffected in later stages of dementia, and "instrumental" activities ofdaily living (such as managing medication, finances, cooking,driving).

"I was interested in understanding how our neuropsychology teststranslated into everyday problems, how our cognitive tests . . . translateinto everyday problems that a person is experiencing and that a caregiveris concerned about," Farias explained.

Farias and her colleagues divided everyday functioning into sevencognitive "domains:" memory, language, semantic or factual knowledge,visual and spatial abilities, planning, organization and dividedattention.

An original list of 138 items was eventually culled to 39, which wasthen tested in 576 older adults: 174 of whom were cognitively normal, 126who had mild cognitive impairment (MCI), and 276 who had been diagnosedwith dementia.

"Informants" (people who had known the patient for an average of almost45 years) provided details on whether the patient could remember shoppingitems without a list, reading a map, balancing the checkbook, and cookingor working and talking at the same time.

Not only did the instrument confirm established diagnoses, it was alsoable to distinguish people with MCI from those with full-blown dementia,meaning it was able to pick up on subtle differences in function.

The results also weren't highly influenced by occupation and educationlevels, as are existing tests.

"This is really the first step in development the instrument," Fariassaid. "What we're really interested in doing is to track people over timeto get a better understanding of the early signs of functionalimpairment."

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