Diagnosis of dementia in a heterogeneous population. Development of a neuropsychological paradigm-based diagnosis of dementia and quantified correction for the effects of education

Y. Stern, H. Andrews, J. Pittman, M. Sano, T. Tatemichi, R. Lantigua and R. Mayeux
Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY.

A brief diagnostic battery of neuropsychological tests was developed for a large-scale epidemiological study of dementia. We operationally defined dementia as defective memory and defective performance in at least two other areas, including orientation, abstract reasoning, construction, and language. Criterion scores for defining defective performance on each test were developed. In a pilot study that used 51 different subjects with a working diagnosis based on physicians' assessment (ie, 32 demented and 29 nondemented subjects), the test-based diagnosis agreed with the working diagnosis in all but two cases. The test battery was then applied to 430 healthy elderly subjects. Eighteen percent of those with 8 or less years of education met criteria for dementia compared with 5% of those with more than 8 years of education. We computed education-corrected scores for each test with the use of residuals from the regression of each test score on education. Based on corrected scores, 12 subjects were reclassified as nondemented and 11 as demented. Subjects who were reclassified as demented were significantly more impaired in activities of daily living than nondemented subjects who were not reclassified. Activities of daily living in subjects who were reclassified as nondemented did not differ from those in demented subjects who were not reclassified. These findings suggest that the neuropsychological battery may have utility in the diagnosis of dementia. However, neuropsychological performance may be influenced by education, and some form of adjustment, such as correction for activities of daily living, may be required in epidemiological studies.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Survival in Alzheimer disease: A multiethnic, population-based study of incident cases
Helzner et al.
Neurology 2008;71:1489-1495.
ABSTRACT | FULL TEXT  

Peripheral A{beta} subspecies as risk biomarkers of Alzheimer's disease
Schupf et al.
Proc. Natl. Acad. Sci. USA 2008;105:14052-14057.
ABSTRACT | FULL TEXT  

Brain Morphology in Older African Americans, Caribbean Hispanics, and Whites From Northern Manhattan
Brickman et al.
Arch Neurol 2008;65:1053-1061.
ABSTRACT | FULL TEXT  

APOE {varepsilon}4 allele predicts faster cognitive decline in mild Alzheimer disease
Cosentino et al.
Neurology 2008;70:1842-1849.
ABSTRACT | FULL TEXT  

Relation of plasma lipids to all-cause mortality in Caucasian, African-American and Hispanic elders
Akerblom et al.
Age Ageing 2008;37:207-213.
ABSTRACT | FULL TEXT  

Hypertension and the Risk of Mild Cognitive Impairment
Reitz et al.
Arch Neurol 2007;64:1734-1740.
ABSTRACT | FULL TEXT  

Leisure Activity and Cognitive Decline in Incident Alzheimer Disease
Helzner et al.
Arch Neurol 2007;64:1749-1754.
ABSTRACT | FULL TEXT  

Mild Parkinsonian Signs and Plasma Homocysteine Concentration in Community-Dwelling Elderly Individuals
Louis et al.
Arch Neurol 2007;64:1646-1651.
ABSTRACT | FULL TEXT  

Mediterranean diet and Alzheimer disease mortality
Scarmeas et al.
Neurology 2007;69:1084-1093.
ABSTRACT | FULL TEXT  

Frailty modifies effectiveness of psychosocial intervention in recovery from stroke
Ertel et al.
Clin Rehabil 2007;21:511-522.
ABSTRACT  

The Association Between Genetic Variants in SORL1 and Alzheimer Disease in an Urban, Multiethnic, Community-Based Cohort
Lee et al.
Arch Neurol 2007;64:501-506.
ABSTRACT | FULL TEXT  

Relation of Diabetes to Mild Cognitive Impairment
Luchsinger et al.
Arch Neurol 2007;64:570-575.
ABSTRACT | FULL TEXT  

Measures of Adiposity and Dementia Risk in Elderly Persons
Luchsinger et al.
Arch Neurol 2007;64:392-398.
ABSTRACT | FULL TEXT  

Relation of Higher Folate Intake to Lower Risk of Alzheimer Disease in the Elderly
Luchsinger et al.
Arch Neurol 2007;64:86-92.
ABSTRACT | FULL TEXT  

Mediterranean Diet, Alzheimer Disease, and Vascular Mediation
Scarmeas et al.
Arch Neurol 2006;63:1709-1717.
ABSTRACT | FULL TEXT  

Apolipoprotein E {varepsilon}4 and Age at Onset of Sporadic and Familial Alzheimer Disease in Caribbean Hispanics
Olarte et al.
Arch Neurol 2006;63:1586-1590.
ABSTRACT | FULL TEXT  

Expanded Genomewide Scan Implicates a Novel Locus at 3q28 Among Caribbean Hispanics With Familial Alzheimer Disease
Lee et al.
Arch Neurol 2006;63:1591-1598.
ABSTRACT | FULL TEXT  

History of vascular disease and mild parkinsonian signs in community-dwelling elderly individuals.
Louis and Luchsinger
Arch Neurol 2006;63:717-722.
ABSTRACT | FULL TEXT  

Stroke and memory performance in elderly persons without dementia.
Reitz et al.
Arch Neurol 2006;63:571-576.
ABSTRACT | FULL TEXT  

Education and rates of cognitive decline in incident Alzheimer's disease.
Scarmeas et al.
J. Neurol. Neurosurg. Psychiatry 2006;77:308-316.
ABSTRACT | FULL TEXT  

An Observational Study of Cognitive Impairment in Amyotrophic Lateral Sclerosis.
Rippon et al.
Arch Neurol 2006;63:345-352.
ABSTRACT | FULL TEXT  

Familial Alzheimer disease in Latinos: Interaction between APOE, stroke, and estrogen replacement
Rippon et al.
Neurology 2006;66:35-40.
ABSTRACT | FULL TEXT  

Implementing Diagnostic Criteria and Estimating Frequency of Mild Cognitive Impairment in an Urban Community
Manly et al.
Arch Neurol 2005;62:1739-1746.
ABSTRACT | FULL TEXT  

Decline in cognitive and functional skills increases mortality risk in nondemented elderly
Schupf et al.
Neurology 2005;65:1218-1226.
ABSTRACT | FULL TEXT  

Medicaid Home Care Services and Survival in New York City
Albert et al.
Gerontologist 2005;45:609-616.
ABSTRACT | FULL TEXT  

Effect of smoking and time on cognitive function in the elderly without dementia
Reitz et al.
Neurology 2005;65:870-875.
ABSTRACT | FULL TEXT  

Aggregation of vascular risk factors and risk of incident Alzheimer disease
Luchsinger et al.
Neurology 2005;65:545-551.
ABSTRACT | FULL TEXT  

Impact of plasma lipids and time on memory performance in healthy elderly without dementia
Reitz et al.
Neurology 2005;64:1378-1383.
ABSTRACT | FULL TEXT  

Association between mild parkinsonian signs and mild cognitive impairment in a community
Louis et al.
Neurology 2005;64:1157-1161.
ABSTRACT | FULL TEXT  

Functional Correlates and Prevalence of Mild Parkinsonian Signs in a Community Population of Older People
Louis et al.
Arch Neurol 2005;62:297-302.
ABSTRACT | FULL TEXT  

Evaluation of HIV RNA and markers of immune activation as predictors of HIV-associated dementia
Sevigny et al.
Neurology 2004;63:2084-2090.
ABSTRACT | FULL TEXT  

Attenuated Central Nervous System Infection in Advanced HIV/AIDS With Combination Antiretroviral Therapy
McArthur et al.
Arch Neurol 2004;61:1687-1696.
ABSTRACT | FULL TEXT  

Hyperinsulinemia and risk of Alzheimer disease
Luchsinger et al.
Neurology 2004;63:1187-1192.
ABSTRACT | FULL TEXT  

APOE and APOC1 Promoter Polymorphisms and the Risk of Alzheimer Disease in African American and Caribbean Hispanic Individuals
Tycko et al.
Arch Neurol 2004;61:1434-1439.
ABSTRACT | FULL TEXT  

Parkinsonian Signs in Older People in a Community-Based Study: Risk of Incident Dementia
Louis et al.
Arch Neurol 2004;61:1273-1276.
ABSTRACT | FULL TEXT  

Lack of Familial Aggregation of Parkinson Disease and Alzheimer Disease
Levy et al.
Arch Neurol 2004;61:1033-1039.
ABSTRACT | FULL TEXT  

Plasma homocysteine levels and risk of Alzheimer disease
Luchsinger et al.
Neurology 2004;62:1972-1976.
ABSTRACT | FULL TEXT  

Relation of Plasma Lipids to Alzheimer Disease and Vascular Dementia
Reitz et al.
Arch Neurol 2004;61:705-714.
ABSTRACT | FULL TEXT  

Stroke and the Risk of Alzheimer Disease
Honig et al.
Arch Neurol 2003;60:1707-1712.
ABSTRACT | FULL TEXT  

Plasma A{beta}40 and A{beta}42 and Alzheimer's disease: Relation to age, mortality, and risk
Mayeux et al.
Neurology 2003;61:1185-1190.
ABSTRACT | FULL TEXT  

Parkinsonian signs in older people: Prevalence and associations with smoking and coffee
Louis et al.
Neurology 2003;61:24-28.
ABSTRACT | FULL TEXT  

Education modifies the relation of AD pathology to level of cognitive function in older persons
Bennett et al.
Neurology 2003;60:1909-1915.
ABSTRACT | FULL TEXT  

Cognition following bilateral implants of embryonic dopamine neurons in PD: A double blind study
Trott et al.
Neurology 2003;60:1938-1943.
ABSTRACT | FULL TEXT  

Antioxidant Vitamin Intake and Risk of Alzheimer Disease
Luchsinger et al.
Arch Neurol 2003;60:203-208.
ABSTRACT | FULL TEXT  

The association of incident dementia with mortality in PD
Levy et al.
Neurology 2002;59:1708-1713.
ABSTRACT | FULL TEXT  

Polymorphisms in the Promoter of the Human APP Gene: Functional Evaluation and Allele Frequencies in Alzheimer Disease
Athan et al.
Arch Neurol 2002;59:1793-1799.
ABSTRACT | FULL TEXT  

Incidence of Dementia After Ischemic Stroke: Results of a Longitudinal Study * Editorial Comment
Desmond et al.
Stroke 2002;33:2254-2262.
ABSTRACT | FULL TEXT  

Mortality in patients with dementia after ischemic stroke
Desmond et al.
Neurology 2002;59:537-543.
ABSTRACT | FULL TEXT  

Caloric Intake and the Risk of Alzheimer Disease
Luchsinger et al.
Arch Neurol 2002;59:1258-1263.
ABSTRACT | FULL TEXT  

Body Mass Index in Essential Tremor
Louis et al.
Arch Neurol 2002;59:1273-1277.
ABSTRACT | FULL TEXT  

Familial Alzheimer Disease Among Caribbean Hispanics: A Reexamination of Its Association With APOE
Romas et al.
Arch Neurol 2002;59:87-91.
ABSTRACT | FULL TEXT  

Influence of leisure activity on the incidence of Alzheimer's Disease
Scarmeas et al.
Neurology 2001;57:2236-2242.
ABSTRACT | FULL TEXT  

A Founder Mutation in Presenilin 1 Causing Early-Onset Alzheimer Disease in Unrelated Caribbean Hispanic Families
Athan et al.
JAMA 2001;286:2257-2263.
ABSTRACT | FULL TEXT  

Diabetes Mellitus and Risk of Alzheimer's Disease and Dementia with Stroke in a Multiethnic Cohort
Luchsinger et al.
Am J Epidemiol 2001;154:635-641.
ABSTRACT | FULL TEXT  

Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan
Tang et al.
Neurology 2001;56:49-56.
ABSTRACT | FULL TEXT  

Applications of Item Response Theory to the Examination of the Psychometric Properties and Differential Item Functioning of the Comprehensive Assessment and Referral Evaluation Dementia Diagnostic Scale among Samples of Latino, African American, and White Non-Latino Elderly
Teresi et al.
Research on Aging 2000;22:738-773.
ABSTRACT  

Motor impairment in PD: Relationship to incident dementia and age
Levy et al.
Neurology 2000;55:539-544.
ABSTRACT | FULL TEXT  

The relationship of hypertension in the elderly to AD, vascular dementia, and cognitive function
Posner et al.
Neurology 2000;58:1175-1181.
ABSTRACT | FULL TEXT  

APOE-{epsilon}4 is associated with memory decline in cognitively impaired elderly
Dik et al.
Neurology 2000;54:1492-1497.
ABSTRACT | FULL TEXT  

Dementia diagnoses from clinical and neuropsychological data compared: The Cache County study
Tschanz et al.
Neurology 2000;54:1290-1296.
ABSTRACT | FULL TEXT  

Frequency and clinical determinants of dementia after ischemic stroke
Desmond et al.
Neurology 2000;54:1124-1131.
ABSTRACT | FULL TEXT  

Risk of Alzheimer's disease in relatives of Parkinson's disease patients with and without dementia
Jacobs et al.
Neurology 2000;54:1208-1209.
FULL TEXT  

Endogenous estrogen levels and Alzheimer's disease among postmenopausal women
Manly et al.
Neurology 2000;54:833-837.
ABSTRACT | FULL TEXT  

Rate of memory decline in AD is related to education and occupation: Cognitive reserve?
Stern et al.
Neurology 1999;53:1942-1942.
ABSTRACT | FULL TEXT  

A Clinicopathological Comparison of Community-Based and Clinic-Based Cohorts of Patients With Dementia
Massoud et al.
Arch Neurol 1999;56:1368-1373.
ABSTRACT | FULL TEXT  

Low-Density Lipoprotein Cholesterol and the Risk of Dementia With Stroke
Moroney et al.
JAMA 1999;282:254-260.
ABSTRACT | FULL TEXT  

Late-Life Depression as a Possible Predictor of Dementia: Cross-Sectional and Short-Term Follow-Up Results
van Reekum et al.
AJGP 1999;7:151-159.
ABSTRACT | FULL TEXT  

Selective decline in memory function among healthy elderly
Small et al.
Neurology 1999;52:1392-1392.
ABSTRACT | FULL TEXT  

The influence of smoking on the risk of Alzheimer's disease
Merchant et al.
Neurology 1999;52:1408-1408.
ABSTRACT | FULL TEXT  

Progression of Parkinsonian Signs in Parkinson Disease
Louis et al.
Arch Neurol 1999;56:334-337.
ABSTRACT | FULL TEXT  

The APOE-{epsilon}4 Allele and the Risk of Alzheimer Disease Among African Americans, Whites, and Hispanics
Tang et al.
JAMA 1998;279:751-755.
ABSTRACT | FULL TEXT  

The Effect of Patient Attrition on Estimates of the Frequency of Dementia Following Stroke
Desmond et al.
Arch Neurol 1998;55:390-394.
ABSTRACT | FULL TEXT  

Dementia as a Predictor of Adverse Outcomes Following Stroke : An Evaluation of Diagnostic Methods
Desmond et al.
Stroke 1998;29:69-74.
ABSTRACT | FULL TEXT  

Clinical Determinants of Poststroke Dementia
Pohjasvaara et al.
Stroke 1998;29:75-81.
ABSTRACT | FULL TEXT  

Recovery of Cognitive Function After Stroke
Desmond et al.
Stroke 1996;27:1798-1803.
ABSTRACT | FULL TEXT  

Risk Factors for Incident Dementia After Stroke: Role of Hypoxic and Ischemic Disorders
Moroney et al.
Stroke 1996;27:1283-1289.
ABSTRACT | FULL TEXT  

Prevalence of Parkinsonian Signs and Associated Mortality in a Community Population of Older People
Bennett et al.
NEJM 1996;334:71-76.
ABSTRACT | FULL TEXT