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      A Subtest of the MMSE as a Valid Test of Episodic Memory? Comparison with the Free and Cued Reminding Test

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          Abstract

          Background/Aims: Episodic memory impairment is known to be the core of Alzheimer’s disease (AD) dementia syndrome and one of the earliest domains to decline. However, episodic memory tests are long and expensive. Methods: In a sample of the French Three-City Study (n = 1,516), we aimed at validating a subtest of the Mini-Mental State Examination (MMSE) specifically measuring episodic memory. We focused on the correlation between 7 MMSE subscores and 4 scores of the Free and Cued Selective Reminding Test (FCSRT) evaluating episodic memory. We performed linear regressions and principal component analyses to identify which MMSE subscores were better correlated with the FCSRT scores. Thereafter, we conducted validation analyses on the whole sample (n = 9,077). Results: We found that subscores for orientation to time and the 3-word recall task were well correlated with FCSRT scores. The summation of these 2 subscores was more strongly associated with dementia and AD than the FCSRT scores and the total MMSE score. Conclusion: Orientation to time and the 3-word recall task might provide a good measure of episodic memory. Making the evaluation of episodic memory faster and cheaper, this finding can be of direct interest for practitioners and epidemiologists.

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          Most cited references14

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          VALIDITY OF THE TRAIL MAKING TEST AS AN INDICATOR OF ORGANIC BRAIN DAMAGE

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            Natural history of mild cognitive impairment in older persons.

            Cognitive abilities of older persons range from normal, to mild cognitive impairment, to dementia. Few large longitudinal studies have compared the natural history of mild cognitive impairment with similar persons without cognitive impairment. Participants were older Catholic clergy without dementia, 211 with mild cognitive impairment and 587 without cognitive impairment, who underwent annual clinical evaluation for AD and an assessment of different cognitive abilities. Cognitive performance tests were summarized to yield a composite measure of global cognitive function and separate summary measures of episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability. The authors compared the risk of death, risk of incident AD, and rates of change in global cognition and different cognitive domains among persons with mild cognitive impairment to those without cognitive impairment. All models controlled for age, sex, and education. On average, persons with mild cognitive impairment had significantly lower scores at baseline in all cognitive domains. Over an average of 4.5 years of follow-up, 30% of persons with mild cognitive impairment died, a rate 1.7 times higher than those without cognitive impairment (95% CI, 1.2 to 2.5). In addition, 64 (34%) persons with mild cognitive impairment developed AD, a rate 3.1 times higher than those without cognitive impairment (95% CI, 2.1 to 4.5). Finally, persons with mild cognitive impairment declined significantly faster on measures of episodic memory, semantic memory, and perceptual speed, but not on measures of working memory or visuospatial ability, as compared with persons without cognitive impairment. Mild cognitive impairment is associated with an increased risk of death and incident AD, and a greater rate of decline in selected cognitive abilities.
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              Neuropsychological measures in normal individuals that predict subsequent cognitive decline.

              To examine neuropsychological measures among normal individuals that predict time to subsequent cognitive decline. Cognitive performance, as measured by 6 neuropsychological tests, was examined at baseline. Participants were followed up for approximately 5 years. Cox proportional hazards models were used to evaluate the neuropsychological measures at baseline that predicted time to progression from normal cognition to mild impairment. Comparable data also examined time to progression from mild impairment to a diagnosis of Alzheimer disease. Community volunteer-based sample examined at a medical institution. One hundred and seven individuals who were cognitively normal and 235 individuals with mild cognitive impairment at baseline. Time to progression from normal cognition to mild impairment and time to progression from mild impairment to a diagnosis of Alzheimer disease. The risk of progressing from normal to mild impairment was considerably greater among those with lower scores on tests of episodic memory (eg, hazard ratio for a 1-SD decrease in the California Verbal Learning Test, 0.55; P<.001). Normal individuals who carried at least 1 copy of the apolipoprotein E epsilon2 allele were less likely to develop cognitive impairments over time than individuals with no epsilon2 allele (hazard ratio for presence of allele, 0.13; P = .006). Measures of both episodic memory and executive function were significant predictors of time to progression from mild impairment to a clinical diagnosis of Alzheimer disease (eg, hazard ratio for a 1-SD decrease in California Verbal Learning Test score, 0.67; P = .005; hazard ratio for a 1-SD increase in the time to complete part B of the Trail Making test, 1.40; P = .007). Among individuals with mild impairments, the apolipoprotein E epsilon4 allele increased risk for Alzheimer disease in a dose-dependent manner; however, this effect was not significant within the context of multivariable models. Episodic memory performance among normal individuals predicts time to progression to mild impairment while apolipoprotein E epsilon2 status is associated with lower risk of cognitive decline among normal individuals. Tests of both episodic memory and executive function are predictors of time to progression from mild impairment to a clinical diagnosis of Alzheimer disease.
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                Author and article information

                Journal
                DEM
                Dement Geriatr Cogn Disord
                10.1159/issn.1420-8008
                Dementia and Geriatric Cognitive Disorders
                S. Karger AG
                1420-8008
                1421-9824
                2009
                June 2009
                25 April 2009
                : 27
                : 5
                : 429-438
                Affiliations
                aInserm, Unit 897, and bUniversity Hospital Center, University Victor Segalen Bordeaux 2, Bordeaux, France
                Article
                214632 Dement Geriatr Cogn Disord 2009;27:429–438
                10.1159/000214632
                19401632
                dadccdc1-3180-4dc7-9a68-c110b663c703
                © 2009 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 27 January 2009
                Page count
                Figures: 1, Tables: 7, References: 40, Pages: 10
                Categories
                Original Research Article

                Geriatric medicine,Neurology,Cardiovascular Medicine,Neurosciences,Clinical Psychology & Psychiatry,Public health
                Neuropsychological tests,Free and Cued Reminding Selective Test,Mini-Mental State Examination,Episodic memory

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