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Mind & Brain, the Journal of Psychiatry


or highly localized neural processes but rather as involving different brain regions according to Bracco et al.,15 we hypothesized that subtests of the CERAD battery refer rather to bihemispheric glucose metabolism in cognitively impaired patients such as MCI and AD. In the present study, we therefore investigated the associations between the different neuropsychological domains as included in the CERAD and changes of regional glucose metabolism in a large sample of patients with AD and its potential preclinical state MCI.


METHODS


Patients and Psychometric Instruments Seventy-five patients (70.598.4 years; 43 female and 32


male)*32 with AD (age: 71.599.1 years; 24 female and 8 male)16 and 43 with MCI (age: 69.797.9 years; 19 female and 24 male) as defined by the criteria of ageing-associated cognitive decline17,18*were consecutively recruited. Patients were under the care of the Section of Geriatric Psychiatry, University Hospital Heidelberg and underwent extensive medical, neurological, neuropsychological, and psychiatric investigation including history taking, physical examination, and laboratory testing as well as cranial MRI and/or computerized tomography scan. The Hachinski Ischemic Score modified by Loeb and Gandolfo19 of the patients was less than 3. Patients showed no focal signs on neurological examination and/or evidence of relevant cerebrovascular changes on brain imaging. Subjects partly participated in previous studies providing separately analyzed data (45; Scho


¨nknecht et al., in press). The study was approved by


the Ethics Committee of the University of Heidelberg. Informed consent was obtained from all participants.


We applied the German version of the CERAD neuropsy-


chological test battery.20 The CERAD was founded in 1986 by the National Institute on Aging to standardize procedures for the evaluation and diagnosis of patients with AD. The CERAD encompasses word list memory, word list recall, word list recognition/subtest correct recognition, wold list recognition/ subtest correct rejection, verbal fluency, modified Boston naming test, constructional praxis, and constructional praxis recall (Table 1). The degree of cognitive impairment was rated on the Mini Mental State Examination.21 The neuropsycholo- gical test performance scores were transformed to ageand education-adjusted z scores.


The word list memory task is a memory task for assessing


immediate word list recall. The task involves presenting the subject with a list of 10 high-frequency, high-imagery words that are shown to him at a constant rate of one word every 2 seconds. The word list is presented three times to the subject; the order of words is randomized for each trial. At the end of each of the three presentations, the subject is asked to recall the list of words; all responses are recorded.


In the delayed word list memory task, the delayed recall of


the list of 10 words presented earlier over three trials is tested. Here, no additional cues are given; the subject must spontaneously recall as many of the 10 words as he can.


M&B 2011; 2:(1). July 2011 2


Table 1. Patient’s Characteristics and Neuropsychological Test Performance Patients


Diagnosis (AD/MCI) n (female/male) Age (years)


MMSE (points)


Word list memory (z score) Word list recall (z score) Word recognition (z score) Correct rejection (z score) Verbal fluency (z score) Naming (z score)


Constructional praxis (z score) Constructional praxis recall (z score)


32/43 43/32


70.598.4 23.395.1 2.691.8 2.391.5 2.893.5 2.897.2 1.691.2 1.392.1 1.292.0 1.891.9


Values are mean9SD. AD, Alzheimer’s disease; MCI, mild cognitive impairment; MMSE, mini mental status examination.


Instructions are: ‘‘Sometime earlier, you read out a list of 10 words, three times from this paper. Please, tell me those words again.’’


The word list recognition task/subtest correct recognition is


an extension of the word list memory task. Here the subject is presented with the original 10 words along with 10 new words; the task is to differentiate the old words from the new ones. The words are read by the subject, in a predetermined order, at the same steady pace of one word every 2 seconds. The subject is asked whether he recognizes the word as the one previously read from the paper. In the word list recognition task/subtest correct rejection, the words correctly recognized as ‘‘not previously read’’ are counted.


The verbal fluency task for categories is a test to assess the verbal reproduction and language functions of the subject. It aims to assess the subject’s ability to think quickly and retrieve from memory words belonging to specific categories (animals). The subject must think of and say as many examples of each as possible, within a specified time period of 1 minute. The naming task assesses language capability; the subject has to name 15 objects. These 15 objects are divided into three groups (low, medium, and high), depend- ing on how frequently they occur and how familiar they are to the target population. Inability to name these familiar objects is a sign of language impairment, specifically impairment of expressive language or speech.


The constructive praxis task refers to a person’s ability to


copy different geometric figures (circle, rhombus, rectangle, cube). This ability includes visual perception and motor execution, and is a visuo-motor construction task. The figures are to be copied by the subject. In the constructional praxis recall test, after a time period of 10 minutes the subject is asked to remember the copied object and to draw it again.


PET Imaging In all patients, PET was performed after at least a 6-hour


fast. Before injection of 225 MBq FDG, blood glucose levels www.slm-psychiatry.com


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