Whole brain segmentation: automated labeling of neuroanatomical structures in the human brain.

Accurate clinical staging of dementia in older subjects has not previously been achieved despite the use of such methods as psychometric testing, behavioural rating, and various combinations of simpler psychometric and behavioural evaluations The Clinical Dementia Rating (CRD), a global rating device, was developed for a prospective study of mild senile dementia--Alzheimer type (SDAT) Reliability, validity, and correlational data are discussed The CRD was found to distinguish unambiguously among older subjects with a wide range of cognitive function, from healthy to severely impaired

A new clinical scale for the staging of dementia.

The concept of cognitive impairment intervening between normal ageing and very early dementia has been in the literature for many years. Recently, the construct of mild cognitive impairment (MCI) has been proposed to designate an early, but abnormal, state of cognitive impairment. MCI has generated a great deal of research from both clinical and research perspectives. Numerous epidemiological studies have documented the accelerated rate of progression to dementia and Alzheimer's disease (AD) in MCI subjects and certain predictor variables appear valid. However, there has been controversy regarding the precise definition of the concept and its implementation in various clinical settings. Clinical subtypes of MCI have been proposed to broaden the concept and include prodromal forms of a variety of dementias. It is suggested that the diagnosis of MCI can be made in a fashion similar to the clinical diagnoses of dementia and AD. An algorithm is presented to assist the clinician in identifying subjects and subclassifying them into the various types of MCI. By refining the criteria for MCI, clinical trials can be designed with appropriate inclusion and exclusion restrictions to allow for the investigation of therapeutics tailored for specific targets and populations.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1365-2796.2004.01388.x

Mild cognitive impairment as a diagnostic entity

Objective
The purpose of this paper is to provide a comprehensive review of information accumulated over the past 26 years regarding the psychometric properties and utility of the Mini-Mental State Examination (MMSE).

Participants
The reviewed studies assessed a wide variety of subjects, ranging from cognitively intact community residents to those with severe cognitive impairment associated with various types of dementing illnesses.

Main Outcome Measures
The validity of the MMSE was compared against a variety of gold standards, including DSM-III-R and NINCDS-ADRDA criteria, clinical diagnoses, Activities of Daily Living measures, and other tests that putatively identify and measure cognitive impairment.

Results
Reliability and construct validity were judged to be satisfactory. Measures of criterion validity showed high levels of sensitivity for moderate-to-severe cognitive impairment and lower levels for mild degrees of impairment. Content analyses revealed the MMSE was highly verbal, and not all items were equally sensitive to cognitive impairment. Items measuring language were judged to be relatively easy and lacked utility for identifying mild language deficits. Overall, MMSE scores were affected by age, education, and cultural background, but not gender.

Conclusions
In general, the MMSE fulfilled its original goal of providing a brief screening test that quantitatively assesses the severity of cognitive impairment and documents cognitive changes occurring over time. The MMSE should not, by itself, be used as a diagnostic tool to identify dementia. Suggestions for the clinical use of the MMSE are made.

The mini-mental state examination: a comprehensive review.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(06)68880-6.pdf

Mild cognitive impairment

• A brief (ten-minute), easily administered battery of four psychological tests was developed to classify successfully 98% of patients with mild dementia of the Alzheimer's type and healthy older persons matched for age, sex, and social position. Only two of 84 persons (one demented, one healthy) were misclassified. The four tests are the logical memory and mental control subtests of the Wechsler Memory Scale, Form A of the Trailmaking Test, and word fluency for letters S and P.

Psychometric differentiation of mild senile dementia of the Alzheimer type.

Clinical investigations of senile dementia of the Alzheimer type require establishment of explicit clinical diagnostic criteria before histological confirmation is possible. Criteria for selection of mildly impaired subjects with senile dementia of Alzheimer type, free of other major disease, are proposed. Problems of recruitment of this select population for a longitudinal study are discussed. A study population with matched healthy control subjects has been enrolled and described. Short term follow-up has provided preliminary support for the diagnostic criteria.

https://jnnp.bmj.com/content/jnnp/45/11/962.full.pdf

Mild senile dementia of Alzheimer type: research diagnostic criteria, recruitment, and description of a study population.

Forty-three subjects with mild senile dementia of the Alzheimer type, diagnosed and staged by clinical research criteria, were studied with clinical, psychometric, EEG, visual evoked potential, and CT measures. During the 12 months following entry into the study, 21 subjects progressed to moderate or severe dementia, 21 remained mild, and one was lost to follow-up. Many of the clinical and psychometric measures of impairment were predictive of the progression to moderate or severe dementia. Electrophysiologic and CT measures were not. In a discriminant function analysis, the scores on two measures (the digit symbol subtest of the Wechsler Adult Intelligence Scale and an Aphasia Battery) correctly predicted the stage of dementia 1 year later in 95% of the subjects.

Predictive features in mild senile dementia of the Alzheimer type

Forty-seven subjects 65 to 80 years of age, of whom 20 were demented and 27 were normal, were studied by computed tomography. Volumetric indices of ventricular (V%) and sulcal size (S%) were determined by pixel counts without knowledge of clinical status. V% was 5.30 (+/- 1.92) for the controls and 10.46 (+/- 4.78) for the demented subjects. S% was 6.14 (+/- 2.51) for the controls and 10.61 (+/- 3.32) for the demented subjects. In each case, differences between the two groups were significant (P less than 0.0001). When a subsample of 29 scans were analyzed using linear and volumetric measurements, the linear measurements showed less pronounced differences between the demented subjects and the controls. These findings explain the conflicting results of different investigators concerning variations in ventricular and sulcal size in dementia and normal aging.

Charles P. Hughes

Papers

A new clinical scale for the staging of dementia.

Psychometric differentiation of mild senile dementia of the Alzheimer type.

Mild senile dementia of Alzheimer type: research diagnostic criteria, recruitment, and description of a study population.

Predictive features in mild senile dementia of the Alzheimer type

Volumetric measurements of the cerebrospinal fluid spaces in demented subjects and controls.