Skip to main content

Outcome Variables in Dementia Trials: Conceptual and Practical Issues

  • Chapter
  • 263 Accesses

Abstract

The aim of this chapter is to determine the roles of different assessment methods (including neuropsychological tests, psychiatric rating scales, global clinical scales and functional scales) in evaluating treatments for dementia, most especially Alzheimer’s disease (AD), with emphasis on neuropsychological assessment in trials of drugs designed to treat cognitive symptoms. We begin with a brief overview of issues in the diagnosis of dementia. We then review the desirable characteristics of instruments for evaluating dementia treatments, followed by a discussion of specific cognitive and other assessment instruments along with data on the extent to which they meet certain desirable validity, reliability and practicality criteria we detail below.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   299.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Small GW, Rabins PV, Barry PP, Buckholtz NS, DeKosky ST, Ferris SH, et al. Diagnosis and treatment of Alzheimer disease and related disorders. Consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer’s Association, and the American Geriatrics Society. JAMA 1997; 278: 1363–1371.

    Article  PubMed  CAS  Google Scholar 

  2. Berrios GE. Dementia during the seventeenth and eighteenth centuries: a conceptual history. Psychol Med 1987; 17: 829–837.

    Article  PubMed  CAS  Google Scholar 

  3. Stuss DT, Levine B. The dementias: nosological and clinical factors related to diagnosis. Brain Cogn 1996; 31: 99–113.

    Article  PubMed  CAS  Google Scholar 

  4. Cummings JL, Benson DR Dementia: a clinical approach. Boston: Butterworth, 1992.

    Google Scholar 

  5. Lawrence AD, Sahakian BJ. The neuropsychology of frontostriatal dementias. In: Woods RT, editor. Handbook of the clinical psychology of ageing. Chichester: Wiley, 1996: 243–265.

    Google Scholar 

  6. Brown RG, Mardsen CD. Subcortical dementia: the neuropsychological evidence. Neuroscience 1988; 25: 363–387.

    Article  PubMed  CAS  Google Scholar 

  7. Antuono P, Doody R, Gilman S, Huff J, Scheltens P, Ueda K, et al. Diagnostic criteria for dementia in clinical trials. Position paper from the International Working Group on Harmonization of Dementia Drug Guidelines. Alzheimer Dis Assoc Disord 1997; 11 (Suppl 3): 22–25.

    PubMed  Google Scholar 

  8. Sahakian BJ. Computerised assessment of neuropsychological function in Alzheimer’s disease and Parkinson’s disease. Int J Geriatr Psychiatry 1990; 5: 211–213.

    Article  Google Scholar 

  9. Leber P. Guidelines for the clinical evaluation of antidementia drugs, first draft. Rockville, MD: US Food and Drug Administration, 1990.

    Google Scholar 

  10. CPMP Working Party on Efficacy of Medicinal Products. Anti-dementia medicinal products. Brussels: Commission of the European Community, 1992.

    Google Scholar 

  11. Charlton BG. Cognitive neuropsychiatry and the future of diagnosis: a “PC” model of the mind. Br J Psychiatry 1995; 167: 149–153.

    Article  PubMed  CAS  Google Scholar 

  12. Morley S, Snaith P. Principles of psychological assessment. In: Freeman C, Tyrer P, editors. Research methods in psychiatry. 2nd ed. London: Gakell, 1992: 135–152.

    Google Scholar 

  13. Lemke E, Wiersma W. Principles of psychological assessment. Chicago: Rand McNally, 1976.

    Google Scholar 

  14. Nunally JC. Psychometric theory. 2nd ed. New York: McGraw-Hill, 1978.

    Google Scholar 

  15. Burgess PW. Theory and methodology in executive function research. In: Rabbitt P, editor. Methodology of frontal and executive functions. Hove: Erlbaum, 1997: 81–116.

    Google Scholar 

  16. Mohs RC. Neuropsychological assessment of patients with Alzheimer’s disease. In: Bloom FE, Kupfer DJ, editors. Psychopharmacology: the fourth generation of progress. New York: Raven Press, 1995: 1377–1388.

    Google Scholar 

  17. Milberg W. Issues in the assessment of cognitive function in dementia. Brain Cogn 1996; 31: 114–132.

    Article  PubMed  CAS  Google Scholar 

  18. Demonet JF, GelyNargeot MC, Bakchine S. Methodological aspects of cognitive assessment. Therapie 1997; 52: 495–498.

    PubMed  CAS  Google Scholar 

  19. Parry CJ, Hodges JR. Spectrum of memory dysfunction in degenerative disease. Curr Opin Neurol 1996; 9: 281–285.

    Article  Google Scholar 

  20. Owen AM, Sahakian BJ, Robbins TW. The role of executive deficits in memory disorders in neurodegenerative disease. In: Troster AI, editor. Memory in neurodegenerative disease: biological, cognitive and clinical perspectives. Cambridge: Cambridge University Press, 1998: 157–171.

    Chapter  Google Scholar 

  21. Cipolotti L, Warrington EK. Neuropsychological assessment. J Neurol Neurosurg Psychiatry 1995; 58: 655–664.

    Article  PubMed  CAS  Google Scholar 

  22. Kuhn T. The structure of scientific revolutions. 2nd ed. Chicago: University of Chicago Press, 1970.

    Google Scholar 

  23. Farah MJ. Neuropsychological inference with an interactive brain: a critique of the “locality” assumption. Behav Brain Sci 1994; 17: 43–104.

    Article  Google Scholar 

  24. Kosslyn SM. Neural systems and psychiatric disorders. Cogn Neuropsychiatry 1996; 1: 89–93.

    Article  PubMed  CAS  Google Scholar 

  25. Lawrence AD. Executive functions and memory in Hunting-ton’s disease. PhD thesis, Department of Experimental Psychology, University of Cambridge, UK, 1997.

    Google Scholar 

  26. Weintraub S, Baratz R, Mesulam MM. Daily living activities in the assessment of dementia. In: Corkin S, editor. Alzheimer’s disease: a report of progress. New York: Raven Press, 1982:189192.

    Google Scholar 

  27. Plaisted KC, Sahakian BJ. Dementia of frontal lobe type: living in the here and now. Aging Mental Health 1997; 1: 293295.

    Google Scholar 

  28. Ferris SH. Diagnosis by specialists: psychological testing. Acta Neurol Scand 1992;Suppl 139: 32–35.

    Google Scholar 

  29. Ferris SH, Lucca U, Mohs R, Dubois B, Wesnes K, Erzigkeit H, et al. Objective psychometric tests in clinical trials of dementia drugs. Alzheimer Dis Assoc Disord 1997; 11 (Suppl 3): 34–38.

    PubMed  Google Scholar 

  30. Cockrell JR, Folstein MF. Mini-Mental State Examination (MMSE). Psychopharmacol Bull 1988; 24: 689–692.

    PubMed  CAS  Google Scholar 

  31. Brandt J, Folstein SE, Folstein ME Differential cognitive impairment in Alzheimer’s disease and Huntington’s disease. Ann Neurol 1988; 23: 555–561.

    Article  PubMed  CAS  Google Scholar 

  32. Reisberg B, Schneider L, Doody R, Anand R, Feldman H, Haraguchi H, et al. Clinical global measures of dementia. Position paper from the International Working Group on Harmonization of Dementia Drug Guidelines. Alzheimer Dis Assoc Disord 1997; 11: 8–18.

    Article  PubMed  Google Scholar 

  33. Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 1968; 114: 797–811.

    Article  PubMed  CAS  Google Scholar 

  34. Roth M, Tym E, Mountjoy CQ, Huppert FA, Hendrie H, Verma S, et al. CAMDEX: a standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry 1987; 149: 698–709.

    Article  Google Scholar 

  35. Huppert FA, Brayne C, Gill C, Paykel ES, Beardsall L. CAMCOG: a concise neuropsychological test to assist dementia diagnosis: sociodemographic determinants in an elderly population sample. Br J Clin Psychol 1995; 34: 529–541.

    Article  PubMed  Google Scholar 

  36. Mohs RC. The Alzheimer’s disease assessment scale. Int Psychogeriatr 1996; 8: 195–203.

    Article  PubMed  CAS  Google Scholar 

  37. Mohs RC, Knopman D, Petersen RC, Ferris SH, Ernesto C, Grundman M, et al. Development of cognitive instruments for use in clinical trials of antidementia drugs: additions to the Alzheimer’s disease assessment scale that broadens its scope. Alzheimer Dis Assoc Disord 1997; 11 (Suppl 2): S13–S21.

    Article  PubMed  Google Scholar 

  38. Mattis S. Mental status examination for organic mental syndrome in the elderly patient. In: Bellack R, Karasu B, editors. Geriatric psychiatry. New York: Grune & Stratton, 1976: 77121.

    Google Scholar 

  39. Erzigkeit H. The SKT: a short cognitive performance test as an instrument for the assessment of clinical efficacy of cognition enhancers: In: Bergener M, Reisberg B, editors. Diagnosis and treatment of senile dementia. Berlin: Springer, 1989: 164–174.

    Google Scholar 

  40. Brazzelli M, Capitani E, Della Salla S, Spinnler H, Zuffi M. A neuropsychological instrument adding to the description of patients with suspected cortical dementia: the Milan Overall Dementia Assessment. J Neurol Neurosurg Psychiatry 1994; 57: 1510–1517.

    Article  PubMed  CAS  Google Scholar 

  41. Capitani E, Manzoni L, Spinnler H. Follow-up of 53 Alzheimer patients with the MODA (Milan Overall Dementia Assessment). Eur J Neurol 1997; 4: 237–239.

    Article  Google Scholar 

  42. Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G, et al. The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). I. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology 1989; 39: 1159–1165.

    Article  PubMed  CAS  Google Scholar 

  43. Fray PJ, Robbins TW. CANTAB battery: proposed utility in neurotoxicology. Neurotoxicol Teratol 1996; 18: 499–504.

    Article  PubMed  CAS  Google Scholar 

  44. Fray PJ, Robbins TW, Sahakian BJ. Neuropsychiatric applications of CANTAB. Int J Geriatr Psychiatry 1996; 11: 329336.

    Google Scholar 

  45. Robbins TW. Dissociating executive functions of the prefrontal cortex. Phil Trans R Soc Lond B 1996; 351: 1463–1471.

    Article  CAS  Google Scholar 

  46. Owen AM. Cognitive planning in humans: neuropsychological, neuroanatomical and neuropharmacological perspectives. Prog Neurobiol 1997; 53: 431–450.

    Article  PubMed  CAS  Google Scholar 

  47. Roberts AC, Sahakian BJ. Comparable tests of cognitive function in monkey and man. In: Sahgal A, editor. Behavioural neuroscience: a practical approach. Oxford: IRL Press, 1993: 165–184.

    Google Scholar 

  48. Forstl H, Sahakian BJ. Thalamic radiodensitiy and cognitive performance in mild and moderate dementia of the Alzheimer type. J Psychiatr Neurosci 1993; 18: 33–37.

    CAS  Google Scholar 

  49. Lawrence AD, Weeks RA, Brooks DJ, Andrews TC, Watkins LHA, Harding AE, et al. The relationship between striatal dopamine receptor binding and cognitive performance in Huntington’s disease. Brain 1998; 121: 1343–1355.

    Article  PubMed  Google Scholar 

  50. CENES Cognition. Personal communication, 1998.

    Google Scholar 

  51. Maruff P, Tyler P, Burt T, Currie B, Burns C, Currie J. Cognitive deficits in Machado-Joseph disease. Ann Neurol 1996; 40: 42 1427.

    Google Scholar 

  52. Robbins TW, Semple J, Kumar R, Truman MI, Shorter J, Ferraro A, et al. Effects of scopolamine on delayed-matchingto-sample and paired associates tests of visual memory and learning in human subjects: comparison with diazepam and implications for dementia. Psychopharmacology 1997; 134: 95106.

    Article  Google Scholar 

  53. Sahakian BJ, Owen AM, Morant NJ, Eagger SA, Boddington S, Crayton L, et al. Crockford HA, Crooks M, Hill K, Levy R. Further analysis of the cognitive effects of tetrahydroaminoacridine (THA) in Alzheimer’s disease: assessment of attentional and mnemonic function using CANTAB. Psychopharmacology 1993; 110: 395–401.

    Article  PubMed  CAS  Google Scholar 

  54. Lange KW, Robbins TW, Marsden CD, James M, Owen AM, Paul GM. L-Dopa withdrawal in Parkinson’s disease selectively impairs cognitive performance in tests of frontal lobe function. Psychopharmacology 1992; 107: 394–404.

    Article  PubMed  CAS  Google Scholar 

  55. Coull JT, Sahakian BJ, Hodges JR. The alpha-2 antagonist idazoxan remediates certain attentional and executive dysfunction in patients with dementia of frontal type. Psychopharmacology 1996; 123: 239–249.

    Article  PubMed  CAS  Google Scholar 

  56. Lawrence AD, Hodges JR, Rosser AE, Kershaw A, ffrenchConstant C, Rubinsztein DC, et al. Evidence for specific cognitive deficits in preclinical Huntington’s disease. Brain 1998; 121: 1329–1341.

    Article  PubMed  Google Scholar 

  57. Sahakian BJ, Elliott R, Low N, Mehta M, Clark RT, Pozniak AL. Neuropsychological deficits in tests of executive function in asymptomatic and symptomatic HIV-1 seropositive men. Psychol Med 1995; 25: 1233–1246.

    Article  PubMed  CAS  Google Scholar 

  58. Simpson PM, Surmon DJ, Wesnes KA, Wilcock GR. The cognitive drug research computerised assessment system for demented patients: a validation study. Int J Geriatr Psychiatry 1991; 6: 95–102.

    Article  Google Scholar 

  59. Wesnes K. The pathology of attention of the dementias. J Psychopharm 1996; 10 (Suppl): A51.

    Google Scholar 

  60. Mohr E, Walker D, Randolph C, Sampson M, Mendis T. Utility of clinical trial batteries in the measurement of Alzheimer’s and Huntington’s dementia. Int Psychogeriatr 1996; 8: 397411.

    Google Scholar 

  61. Ferris SH, Flicker C, Reisberg B. NYU computerised test battery for assessing cognition in aging and dementia. Psychopharmacol Bull 1988; 24: 699–702.

    PubMed  CAS  Google Scholar 

  62. Flicker C, Dean R, Bartus RT, Ferris SH, Crook T. Animal and human-memory dysfunctions associated with aging, cholinergic lesions, and senile dementia. Ann NY Acad Sci 1985; 444: 515–517.

    Article  PubMed  CAS  Google Scholar 

  63. Larrabee GJ, Crook T. A computerised everyday memory battery for assessing treatment effects. Psychopharmacol Bull 1988; 24: 695–697.

    PubMed  CAS  Google Scholar 

  64. Gauthier S, Bodick N, Erzigkeit E, Feldman H, Geldmacher DS, Huff J, et al. Activities of daily living as an outcome measure in clinical trials of dementia drugs. Alzheimer Dis Assoc Disord 1997; 11 (Suppl 3): 56-S7.

    PubMed  Google Scholar 

  65. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. JAMA 1963; 185: 914–919.

    Article  PubMed  CAS  Google Scholar 

  66. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994.

    Google Scholar 

  67. World Health Organization. The ICD-10 classification of mental and behavioural disorders. Geneva: World Health Organization, 1992.

    Google Scholar 

  68. Galasko D, Bennett D, Sano M, Ernesto C, Thomas R, Grund-man M, et al. An inventory to assess activities of daily living for clinical trials in Alzheimer’s disease. Alzheimer Dis Assoc Disord 1997; 11 (Suppl 2): 533-S39.

    Google Scholar 

  69. Morris JC. The clinical dementia rating (CDR): current version and scoring rules. Neurology 1993; 43: 2412–2414.

    Article  PubMed  CAS  Google Scholar 

  70. Reisberg B, Ferris SH, de Leon MJ, Crook T. The global deterioration scale for assessment of primary degenerative dementia. Am J Psychiatry 1982; 139: 1136–1139.

    PubMed  CAS  Google Scholar 

  71. Guy W. ECDEU assessment manual. Rockville, MD: US Department of Health Education and Welfare publication no. (ADM) 76–338, 1976.

    Google Scholar 

  72. Ferris SH, Mackell JA, Mohs R, et al. A multicenter evaluation of new treatment efficacy instruments for Alzheimer disease clinical trials: overview and general results. Alzheimer Dis Assoc Disord 1997; 11 (Suppl 1): S1–S2.

    Article  PubMed  Google Scholar 

  73. Knopman DS, Knapp MJ, Gracon SI, Davis CS. The clinician interview based impression (CIBI): a clinician’s global change rating scale in Alzheimer’s disease. Neurology 1994; 44: 2315 2321.

    Google Scholar 

  74. Knapp MJ, Knopman DS, Solomon PR, et al. A 30-week randomized controlled trial of high-dose tacrine in patients with Alzheimer’s disease. JAMA 1994; 271: 985–991.

    Article  PubMed  CAS  Google Scholar 

  75. Rogers S, Doody RS, Mohs R, Friedhoff L. E-2020 produces both clinical global and cognitive test improvement in patients with mild to moderatley severe Alzheimer’s disease (AD): results of a 30 week Phase III trial. Neurology 1996; 46: A217.

    Google Scholar 

  76. Weiner MF, Koss E, Wild KV, Folks DG, Tariot P, Luszczynska H, et al. Measures of psychiatric symptoms in Alzheimer patients: a review. Alzheimer Dis Assoc Disord 1996; 10: 20–30.

    PubMed  CAS  Google Scholar 

  77. Homma A, Brodaty H, Bruno G, Cummings JL, Gilman S, Gracon S, et al. Clinical trials of treatment for noncognitive symptoms of dementia. Position paper from the International Working Group on Harmonization of Dementia Drug Guidelines. Alzheimer Dis Assoc Disord 1997; 11 (Suppl 3): S54–S55.

    Google Scholar 

  78. Ferris SH, Mackell JA. Behavioral outcomes in clinical trials for Alzheimer disease. Alzheimer Dis Assoc Disord 1997; 11 (Suppl 4): S10–S15.

    PubMed  Google Scholar 

  79. Reisberg B, Auer SR, Monteiro IM. Behavior pathology in Alzheimer’s disease (BEHAVE-AD) rating scale. Int Psychogeriatr 1996; 8 (Suppl 3): 301–308.

    Article  PubMed  Google Scholar 

  80. Tariot PN, Mack JL, Patterson MB, et al. The behavior rating scale for dementia of the Consortium to Establish a Registry of Alzheimer’s Disease. Am J Psychiatry 1995; 152: 1349–1357.

    PubMed  CAS  Google Scholar 

  81. Koss E, Weiner M, Ernesto C, Cohen-Mansfield J, Ferris SH, Grundman M, Schafer K, Sano M, Thal LJ, Thomas R, Whitehouse PJ. Assessing patterns of agitation in Alzheimer’s disease patients with the Cohen-Mansfield agitation inventory. Alzheimer Dis Assoc Disord 1997; 11 (Suppl 2): 545–550.

    Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2001 Springer-Verlag London

About this chapter

Cite this chapter

Lawrence, A.D., Sahakian, B.J. (2001). Outcome Variables in Dementia Trials: Conceptual and Practical Issues. In: Guiloff, R.J. (eds) Clinical Trials in Neurology. Springer, London. https://doi.org/10.1007/978-1-4471-3787-0_15

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-3787-0_15

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84996-856-0

  • Online ISBN: 978-1-4471-3787-0

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics