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SIMPLE NEW SCREEN FOR MILD DEMENTIA
MADRID—The AD8, an eight-item questionnaire, is an excellent self-rating tool for detecting cognitive change due to dementia, researchers reported at the 10th International Conference on Alzheimer’s Disease and Related Disorders. Use of the AD8 combined with brief objective measures of performance should increase the clinician’s ability to detect dementia at the earliest stages and begin appropriate treatment, according to James E. Galvin, MD, MSc.
The AD8 requires respondents to answer "yes," "no," or "not applicable" regarding whether they have increasingly noticed problems with judgment and have shown a decreased interest in hobbies and activities and a tendency to repeat questions or statements. Questions also focus on whether patients have difficulty learning how to use tools, appliances, or gadgets and whether they forget the correct month or year, have trouble handling financial affairs or remembering appointments, and have daily problems with thinking and/ or memory. An endorsement of two or more items on the AD8 is indicative of dementia.
EIGHT IS ENOUGH
Dr. Galvin, Assistant Professor of Neurology and Neurobiology at the Alzheimer’s Disease Research Center at Washington University School of Medicine in St. Louis, and his associates examined how the AD8 fares as a self-rating tool compared with both informant and clinician impression of cognitive status.
Three hundred twenty-five patients and their informants (usually a spouse) separately completed the AD8 questionnaire. The number of AD8 items endorsed by the subject was compared with the number endorsed by the informant, with independently derived Clinical Dementia Rating (CDR) scores, and with depression ratings.
Results showed that the informant was able to reliably discriminate changes in the patient’s cognitive abilities that corresponded highly with the physician’s assessment of the patient’s cognitive status. The sensitivity of informants’ AD8 rating was 84%, with a specificity of 93% and a positive predictive value of 85%. Informants were able to correctly classify the presence of dementia 90% of the time, as determined by their answers to the eight items included in the AD8.
KNOW THYSELF
Self-rating scales for dementia have not been popular because of the perception that patients with even mild dementia lack insight and deny cognitive problems, according to Dr. Galvin. In his study, however, patients were able to use the AD8 to accurately rate their own cognitive function; these ratings corresponded well with physician assessments of patients’ cognitive status via the CDR. Though informants are likely to be more observant, patients correctly classified the presence of dementia 74% of the time by completing the AD8, Dr. Galvin noted, adding that "in real-life situations, a reliable informant may not always be available."
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—Jill Stein
Suggested Reading
Galvin JE, Roe CM, Powlishta KK, et al. The AD8: a brief informant interview to detect dementia. Neurology. 2005; 65:559-564.
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