COGselftest - Online Dementia and Alzheimer’s Screening Tool

While all self-diagnosing tests have particular limitations, they might be quite useful as the first evaluation mechanism, helping to check yours, or your loved one, cognitive status without complications and unnecessary expenses. Scientifically developed, interactive, clinician-verified cognitive test that identifies changes potentially associated with Alzheimer’s and other forms of dementia with about 96 percent of outcomes’ accuracy now is available online to the general public.

Alzheimer’s is the sixth leading cause of death in the U.S. and the fifth leading cause of death for those ages 65 and older. However, it is known that sixty percent (60%) of people with early signs of Alzheimer's disease (AD) go undiagnosed. That means they miss the opportunity to delay the onset of the disease with early treatment.

Early detection of Alzheimer's disease and dementia is possible with the COGselftest. It is a simple, computer-based tool that helps you to detect the very early signs of Alzheimer's disease. If early signs of AD are detected, you can potentially delay the onset of the disease for several years through preventative measures and consistent monitoring. Of people with signs of mild cognitive impairment (that is, in only one cognitive domain) 7 percent to 8 percent per year convert to Alzheimer's.

AD develops slowly, and with early detection and treatment, it is possible to delay the onset of symptoms when treatment begins early.

"Because we are beginning to see a shift in this practice, we wanted to develop a modern test that is computer-based, internet-accessible and can be taken by an individual themselves independently with rudimentary computer skills,” said John H. Dougherty, Jr. M.D., Cole Neuroscience Center at the University of Tennessee Medical Center, Knoxville, Medical Director.

Taking less than 10 minutes to complete, the COGselftestTM makes it easy for people to understand and monitor their brain health. While there is no cure today for Alzheimer’s, lifestyle changes can delay the onset of serious cognitive decline.

A leading neurologist, Dougherty has specialized in Alzheimer’s disease for 18 of his 25+ years in the field.

Dougherty’s research showed a series of disease patterns for Alzheimer’s and other types of dementia. These patterns allow individuals and their doctors to identify cognitive changes that can lead to critical gains in early treatment.

Unlike existing paper and pencil tests, the COGselftest screens all six cognitive domains—from visual- spacial, executive function and verbal fluency to memory, attention and orientation—pinpointing those that may have early warning signs of cognitive impairment.

“If one can put off the symptoms of Alzheimer’s disease three to five years, it may change the basic epidemiology of the disease in a very important way,” said Dougherty. He and his medical team currently follow more than 3,000 patients.

Individuals receive a confidential, detailed report that compares their score to an age-matched control group. People can use the COGselftestTM to monitor their brain health and identify problems that can be shared with their physician.

The screening also can be an important evaluation tool for someone concerned about a family member or friend.

What will the COGselftest tell you?

The COGselftest identifies impairment in the six major areas, or cognitive domains, that are likely to be impaired by dementia:

* Orientation: The awareness of time, place, situation and self.

* Visuo-spatial ability: The ability to visualize, organize, manipulate and recreate objects.

* Verbal fluency: The ability to quickly and accurately use language.

*Memory: The ability to recall information and previous experiences as well as to learn and store new information.

* Attention: The ability to concentrate and focus on information without being easily distracted.

* Executive processing: The ability to reason and make decisions and judgments.

By assessing your responses in each area, the COGselftest can help you and your doctor to identify areas that may need attention and help you monitor changes and improvements.

Cost

Cost for a one-time use is $24.95, three-time use is $49.95. The cognitive test includes Doughtery’s e-book, “Better Brain Health,” a 65-page guidebook that helps people understand and improve their brain health.

Video Presentation

Website: http://www.CognitiveTest.com

Sources and Additional Information:

http://www.cognitivetest.com/

http://cogselftest.com/

http://www.prweb.com/releases/cogselftest/alzheimers_screening/prweb10758759.htm

SAGE test for Mild Cognitive Impairment and Early Dementia

SAGE is a brief self-administered cognitive screening instrument to identify Mild Cognitive Impairment (MCI) and early dementia. It was developed by the Ohio State University Medical Center to provides the self-tested preliminary guidance for the early signs of dementia.

Average time to complete the test is 10 to 15 minutes. The total possible points are 22.

Administration

The test is self-administered. There are four forms of the SAGE test. Only one test form should be given. It does not matter which form is taken, as they are all interchangeable.

All forms are in Adobe Portable Document (PDF) Format and require Adobe Reader. SAGE should be filled out in ink without the assistance of others. Inform the examinee that there are four pages to complete. Calendars and clocks should not be available during the testing. Do not answer specific questions. Just say, "Do the best that you can."

Questionnaires

Download SAGE test form 1

Download SAGE test form 2

Download SAGE test form 3

Download SAGE test form 4

Scoring

Average time to complete the test is 15 minutes. The maximum score is 22. A score of 17 and above is considered normal. 

Download Scoring Instructions

Interpretation

Please note that SAGE screening is not a diagnostic test of any condition. Research has shown that SAGE can often, but not always, indicate whether individuals fall into the normal range, have mild memory or thinking impairments, or have a more severe memory or thinking condition.  Please see the table below. 

17 to 22 - Individuals with these scores are very likely to be normal.

15 and 16 - Individuals with these scores are likely to have mild memory or thinking impairments. Further evaluation by a physician is recommended.

14 and below - Individuals with these scores are likely to have a more severe memory or thinking condition. Further evaluation by a physician is recommended.

About SAGE Test

Dr. Douglas Scharre, a neurologist at the Ohio State University Medical Center, developed the Self-Administered Gerocognitive Examination (SAGE) to help identify individuals with mild thinking and memory impairments at an early stage. The research shows four out of five people (80 percent) with mild thinking and memory (cognitive) issues will be detected by this test, and 95% of people who are normal thinking will have normal SAGE scores.

Scharre, who specializes in treating Alzheimer’s disease, said treatments for Alzheimer’s and dementia are more effective when they are introduced in the earliest stage of the disease. Unfortunately, he said he often sees patients more than three to four years after the first symptoms of a cognitive impairment began to appear.

“It’s a recurring problem,” said Scharre. “People don’t come in early enough for a diagnosis, or families generally resist making the appointment because they don’t want confirmation of their worst fears. Whatever the reason, it’s unfortunate because the drugs we’re using now work better the earlier they are started.”

Many of the assessment tools for cognitive disorders being used today, while accurate, have aspects that deter their use. “Seldom are physicians reimbursed for the time and effort it takes to give such tests, or they tie up personnel to physically administer the test,” said Scharre, who advocates the use of routine screening for cognitive disorders in the primary care setting. Other diagnostic tests require the patient to use a computer, which can add heightened anxiety to some older adults who may be infrequent users of technology.

It only takes a paper, pen and a few minutes to take the test and because it’s self-administered, it doesn’t necessarily take time away from the appointment. “They can take the test in the waiting room while waiting for the doctor,” said Scharre.

Missing six or more points on the 22-point SAGE test usually warrants additional follow-up by the physician. Abnormal results can also prompt an early search for reversible and treatable conditions that may be causing the patient’s thinking and memory impairment. Many conditions besides Alzheimer’s disease, such as strokes and some thyroid conditions, can also impact memory, according to Scharre.

Scharre said there are potential cost savings to using the tests in a primary care setting. He reasons that a person who fares poorly on the self-exam will likely be less compliant taking medications on time, taking them in the proper dosages or following other recommendations such as maintaining healthy diets.

“Abnormal test results can serve as an early warning to the patient’s family,” added Scharre. “The results can be a signal that caregivers may need to begin closer monitoring of the patient to ensure their safety and good health is not compromised and that they are protected from financial predators.” Results of the new test compare favorably with current standard cognitive assessments that are not self-administered.

To validate the exam’s findings and accuracy, Scharre and other researchers at Ohio State evaluated study participants using SAGE, and then evaluated the same subjects with a battery of other established and well-documented assessment tools.

The study involved 254 study participants, 59 years of age or older, who took the SAGE self-assessment. Sixty-three (63) individuals were randomly selected to have a one-day clinical evaluation utilizing a battery of physical, neurological and cognitive tests.

SAGE scores compared favorably with the mini-mental state examination (MMSE), a brief questionnaire test that is commonly used in medicine to screen for cognitive impairments and dementia.

Both tests were able to differentiate clinically defined normal and mild cognitive improvement from subjects with dementia. However, SAGE, but not MMSE, was also able to distinguish between clinically defined normal from the mild cognitive improvement group.

PET scans to predict Alzheimer's

Introduction

A PET scan (positron emission tomography) is imaging tests that can help reveal how your tissues and organs are functioning. To show this chemical activity, a small amount of radioactive material must enter your body.

The precise type of radioactive material, and its delivery method, depends on which organ or tissue is being studied by the PET scan. The radioactive material may be injected into a vein, inhaled or swallowed.

More radioactive material accumulates in areas that have higher levels of chemical activity. This often corresponds to areas of disease and shows up as brighter spots on the PET scan. A PET scan is useful in evaluating a variety of conditions — including neurological problems, heart disease and cancer.

Recent researches confirmed that a PET scan can show the brain's biological changes attributable to Alzheimer's disease before any other diagnostic test with significant degree of the results reliability. Alzheimer's disease can even be detected several years earlier than the onset of symptoms. Early detection and confirmation of Alzheimer's disease allows for:

• Early drug therapy to slow the loss of the patient's ability to function.
• Future planning before loss of mental capacity.
• Positive and accurate diagnosis of other dementing processes, chronic depression and normal aging.
• Help in the discovery and development of new therapies.
• Hope.

PET scan for Alzheimer’s

PET imaging has been confirmed as being one of the most accurate predictors of Alzheimer’s disease out of all of the different types of medical diagnostic imaging procedures available. A PET scan image of Alzheimers is able to show a physician the biological changes in the brain caused by Alzheimer’s disease. A recent study taken at UCLA, the California based university, have shown that PET imaging improves a doctor’s ability to forecast a patient’s future cognitive functions by up to 30%. This find relates to Alzheimer’s detection as PET imaging increases the ability of a physician to predict, in patients with early memory complaints, whether this condition will significantly worsen in the years following the initial exam.

PET scans for Alzheimer’s disease involves the administration of a radioactive tracer that is a combination of a radioisotope (a radioactive compound whose movements are detectable by a PET scanner) with a natural body compound. In Alzheimer’s diagnosis, the radioactive tracer used in the Positron Emission Tomography procedure is Fluorodeoxyglucose (FDG), which combines the natural body compound glucose with the radioisotope Fluorine-18. This radioactive tracer, or radiopharmaceutical, is used in Alzheimer’s diagnosis as the radioactive compound that it uses has a short half-life and will disappear from the body within hours. Therefore, PET scans for Alzheimer’s are safe and the patient should not have any worry about the radiation content of this procedure.

Additionally, Alzheimer’s PET scans use FDG as it contains the body compound glucose. The use of FDG, which shares a similar structure to glucose, is important, as the absorption of glucose is effective in determining the metabolic activity of the brain. In Alzheimer’s disease and other forms of dementia, the brain produces a metabolic pattern that is significantly different from the metabolic pattern of healthy brain cells. As PET imaging examines the metabolic activity of brain cells by tracing how FDG is absorbed, it is able to detect Alzheimer’s disease and other forms of dementia.

Additionally, recent studies have confirmed the effectiveness of Positron Emission Tomography in distinguishing Alzheimer’s disease from other forms of dementia. This is because Alzheimer’s disease has a metabolic abnormality (bilateral temporoparietal hypometabolism) that is significantly different from metabolic abnormalities found in other forms of dementia.

PET scan of Alzheimer’s have increased in recent years as PET imaging provides a noninvasive, painless way for physicians to confirm the presence of Alzheimer’s in patients. Traditionally, autopsy or biopsy was considered the only methods to absolutely confirm the presence of Alzheimer’s disease. With PET technology, it is now possible to identify Alzheimer’s in its early phase and subsequently use new drug therapies to delay its progression.

Recent medical studies have pointed to the possible effectiveness of using PET scanning of the hippocampus as a way to detect Alzheimer’s disease while in its early stages. It is a well-known medical fact that the hippocampus, a region of the bran that is instrumental in learning and short-term memory, is affected in the early stages of Alzheimer’s disease. It is believed that through a PET scan of hippocampus that it will be possible to see the first signs of Alzheimer’s disease long before it has spread to the cerebral cortex, which damages cognitive function and impairs the memory. Future studies on the viability of a PET scan of hippocampus have been undertaken to further the use of PET scanning for detecting Alzheimer’s disease.

In the latest studies, a new type of PET scan has been used to detect Alzheimer's non-invasively. It also gives results that are as good as doing an autopsy. The brain of a person with Alzheimer's contains abnormal proteins that form deposits and tangles (or more specifically, amyloid senile plaques and tau neurofibrillary tangles) in the cortical region. However, the most reliable method of finding these proteins while the patient is alive is by surgical removal of brain tissue, an invasive and potentially risky procedure. Some scanning methods exist but they are not as reliable. Scientists have now come up with what appears to be a reliable non-invasive method of detecting these Alzheimer "markers" using a PET scan and a new tracer chemical called FDDNP that binds effectively to abnormal protein plaques and tangles.  A PET scan gives a three dimensional, computer enhanced and highly colorful "blurry-looking" image of the brain as it traces a positron emitting chemical (in this case FDDNP) after it is injected into the patient and travels through the tiny blood vessels in the brain. Any abnormal protein plaques and tangles show up because the FDDNP will stick to them.

While the usefulness of the PET scan results for early Alzheimer’s detection is already proven, the potential for this method is still huge, so we will see more and more intense research in this direction and hopefully even more promising results.

Sources and Additional Information:

http://www.scienceblog.com/cms/node/2042

http://www.mayoclinic.com/health/pet-scan/MY00238

http://www.bodyscanoflouisville.com/zportal/portals/pat/brain/Alzheimers_Disease

http://www.radiology-info.org/nuclear-medicine-positron-emission-tomography/pet-scan-alzheimers-disease.html

http://www.webmd.com/alzheimers/news/20080811/pet-scans-spot-early-alzheimers

http://www.medpagetoday.com/Neurology/AlzheimersDisease/18738

Using MRI to Predict Alzheimer’s

A new method of brain imaging identifies a pattern of regional brain atrophy in patients with mild cognitive impairment (MCI). The finding indicates a greater likelihood of progression to Alzheimer’s disease.

“Previously, this pattern has been observed only after a diagnosis of probable Alzheimer’s disease,” said the study’s lead author, Linda K. McEvoy, Ph.D, assistant project scientist in the Department of Radiology at the University of California San Diego School of Medicine in La Jolla.

“Our results show that some individuals with MCI have the atrophy pattern characteristic of mild Alzheimer’s disease, and these people are at higher risk of experiencing a faster rate of brain degeneration and a faster decline to dementia than individuals with MCI who do not show that atrophy pattern.”

According to the Alzheimer’s Association, more than five million Americans currently have Alzheimer’s disease. One of the goals of modern neuro-imaging is to help in early and accurate diagnosis, which can be challenging. There is no cure for Alzheimer’s disease, but when it is diagnosed early, drug treatment may help improve or stabilize patient symptoms.

In Alzheimer’s disease, nerve cell death and tissue loss cause areas of the brain to atrophy. Structural MRI allows radiologists to visualize subtle anatomic changes in the brain that signal atrophy. MCI is associated with an increased risk of progression to Alzheimer’s disease.

Rates of progression vary. Some patients progress rapidly, while others remain stable for relatively long periods of time.

For the study, Dr. McEvoy and colleagues set out to determine if they could identify a pattern of regional atrophy characteristic of mild Alzheimer’s disease in order to aid in the prediction of cognitive decline in patients with MCI.

In the study, the researchers analyzed brain MR images from 84 patients with mild Alzheimer’s disease, 175 patients with MCI and 139 healthy controls, using with semi-automated, individually specific quantitative MRI methods. The results showed widespread cortical atrophy in some patients with MCI, involving all cortical areas except those involved with processing of primary motor and sensory information.

However, most indicative of future cognitive decline were atrophy in parts of the medial and lateral temporal lobes and in the frontal lobes. This pattern was also present in the patients with mild Alzheimer’s disease.

“Although these individuals are reporting problems mainly with memory, the atrophy involves more than just memory areas, extending into brain regions involved in planning, organization, problem solving and language,” Dr. McEvoy said.

Followup data were available for 160 patients with MCI. The patients exhibiting atrophy in the brain regions described above showed significant one-year clinical decline and structural brain loss and were more likely to progress to a probable diagnosis of Alzheimer’s disease. MCI patients without that pattern of atrophy remained stable after a year.

Dr. McEvoy hopes that these findings will have an impact on the design of clinical trials to test medications that may slow or halt the progression of Alzheimer’s disease.

“Currently there are no treatments that will prevent or cure Alzheimer’s disease, but information about risk of rapid decline may help patients with MCI and their families plan for the future,” Dr. McEvoy said.

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The latest 2009 study confirmed the findings several previous researches, producing similar outcomes. For example, the study of 2003 documents signatures of the early brain changes, occurring several years before the memory problems of early Alzheimer's actually show up.  These changes are caused by loss of brain cells, writes lead researcher Henry Rusinek, PhD, a professor of radiology at New York University School of Medicine in New York City. The researchers say that other studies have pointed to the medial temporal lobe, a small section of the brain, as being very vulnerable to the aging process. These studies show that these changes are also seen in the early stages of Alzheimer's disease. That means mean looking for these brain changes could help pinpoint who is likely to go on to develop Alzheimer's disease in the nearest future.

MRI scans that detect shrinkage in specific regions of the mid-brain attacked by Alzheimer’s disease accurately diagnose the neurodegenerative disease, even before dementia symptoms interfere with daily function, a 2008 study by the Florida Alzheimer’s Disease Research Center (ADRC) in Miami and Tampa found.

“We advocate, based on these findings, that the criteria for the diagnosis of Alzheimer’s disease should include MRI scans,” said the study’s lead author Ranjan Duara, MD, medical director of the Wien Center for Alzheimer’s Disease and Memory Disorders at Mount Sinai Medical Center. “By incorporating MRIs into the assessment of patients with memory problems, early diagnosis can be standardized and done far more accurately.”

“This study demonstrates that MRI brain scans are accurate enough to be clinically useful, both in diagnosing Alzheimer’s disease itself at an early stage and in identifying people at risk of developing Alzheimer’s,” said Florida ADRC Director Huntington Potter, PhD, a neuroscientist at the Byrd Alzheimer’s Center and Research Institute, University of South Florida.

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While locating the area of the AD marker place in the brain remains a most significant direction of research, the following analysis can be automated by using the special software.  Massachusetts General Hospital researchers are using automated MRI software to detect individuals in the preclinical phase of Alzheimer's disease with 95% accuracy.

Dr. Rahul Desikan, a researcher at MGH, and colleagues identified which regions of the brain are affected by AD and mild cognitive impairment in two patient groups of 97 and 216, respectively. Based on earlier pathological and imaging studies, the investigators confirmed that those with AD or MCI demonstrate a significant difference in thickness and volume in their entorhinal cortex, hippocampus, and supramarginal gyrus. The researchers then processed MRI scans of individuals with AD and MCI using FreeSurfer, open source software developed at MGH and the University of California, San Diego

Sources and Additional Information:

http://psychcentral.com/news/2009/02/12/mri-predicts-alzheimers/4059.html

http://www.webmd.com/alzheimers/news/20031125/mri-brain-scan-predicts-memory-decline

http://ihealthbulletin.com/blog/2008/12/21/mri-diagnosis-predict-alzheimers-disease/

http://www.psychiatrictimes.com/alzheimer/content/article/113619/1451362