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Vol. 5, No. 3-4, 2008
Issue release date: March 2008
Free Access
Neurodegenerative Dis 2008;5:261–263
(DOI:10.1159/000113719)

Assessing Change in Cognitive Function in Dementia: The Relative Utilities of the Alzheimer’s Disease Assessment Scale – Cognitive Subscale and the Cognitive Drug Research System

Wesnes K.A.
Cognitive Drug Research Ltd., Goring-on-Thames, and Human Cognitive Neuroscience Unit, Northumbria University, Newcastle upon Tyne, UK; Brain Sciences Institute, Swinburne University, Hawthorn, Vic., Australia
email Corresponding Author

Abstract

This paper considers the suitability of the Alzheimer’s Disease Assessment Scale – Cognitive Subscale (ADAS-cog) as the gold standard in registration trials of treatments for Alzheimer’s disease. Working groups have recommended replacing the ADAS-cog if suitable automated alternatives can be found. This paper makes the case for the Cognitive Drug Research (CDR) computerised cognitive assessment system, as an example of a suitable instrument to replace the ADAS-cog. The CDR system has been widely used in dementia work for 20 years and shows good correlations to the ADAS-cog, while additionally assessing the domains of attention, working memory, information processing and retrieval speed of information held in memory. The utility of the system in evaluating and differentiating the major dementias will be described, as well as its ability to track deterioration over time. Its validation as a core measure of cognitive dysfunction in the dementias will be described, as will work showing that various CDR measures relate closely to activities of daily living. The sensitivity of the CDR system to anticholinesterases will be described in Alzheimer’s disease, dementia with Lewy bodies and Parkinson’s dementia. Finally, the CDR system has a large normative database which allows treatment effects in dementia to be put into an unambiguous clinical perspective.


 goto top of outline Key Words

  • The Cognitive Drug Research system
  • Alzheimer’s Disease Assessment Scale – Cognitive Subscale
  • Alzheimer’s disease
  • Dementia with Lewy bodies
  • Parkinson’s dementia

 goto top of outline Abstract

This paper considers the suitability of the Alzheimer’s Disease Assessment Scale – Cognitive Subscale (ADAS-cog) as the gold standard in registration trials of treatments for Alzheimer’s disease. Working groups have recommended replacing the ADAS-cog if suitable automated alternatives can be found. This paper makes the case for the Cognitive Drug Research (CDR) computerised cognitive assessment system, as an example of a suitable instrument to replace the ADAS-cog. The CDR system has been widely used in dementia work for 20 years and shows good correlations to the ADAS-cog, while additionally assessing the domains of attention, working memory, information processing and retrieval speed of information held in memory. The utility of the system in evaluating and differentiating the major dementias will be described, as well as its ability to track deterioration over time. Its validation as a core measure of cognitive dysfunction in the dementias will be described, as will work showing that various CDR measures relate closely to activities of daily living. The sensitivity of the CDR system to anticholinesterases will be described in Alzheimer’s disease, dementia with Lewy bodies and Parkinson’s dementia. Finally, the CDR system has a large normative database which allows treatment effects in dementia to be put into an unambiguous clinical perspective.

Copyright © 2008 S. Karger AG, Basel


 goto top of outline References
  1. Wesnes K, Harrison J: The evaluation of cognitive function in the dementias: methodological and regulatory considerations. Dialogues Clin Neurosci 2003;5:77–88.
  2. Ferris S, Lucca U, Mohs R, Dubois B, Wesnes K, Erzigkeit H, Geldmacher D, Bodick N: Objective psychometric tests in clinical trials of dementia drugs. Position paper from the International Working Group on Harmonization of Dementia Drug Guidelines. Alzheimer Dis Assoc Disord 1997;11(suppl 3):34–38.

    External Resources

  3. Simpson PM, Surmon DJ, Wesnes KA, Wilcock GK: The Cognitive Drug Research computerised assessment system for demented patients: a validation study. Int J Geriatr Psychiatry 1991;6:95–102.

    External Resources

  4. Wesnes KA, McKeith IG, Ferrara R, Emre M, Del Ser T, Spano PF, Cicin-Sain A, Anand R, Spiegel R: Effects of rivastigmine on cognitive function in dementia with Lewy bodies: a randomised placebo-controlled international study using the Cognitive Drug Research computerised assessment system. Dement Geriatr Cogn Disord 2002;13:183–192.
  5. Wesnes KA, Harrison J, Edgar C, Pincock C: The sensitivity and reliability of the Cognitive Drug Research computerised cognitive assessment system to disease progression and treatment response in Alzheimer’s disease. Int Psychogeriatr 2005;17(suppl 2):154.
  6. Bronnick K, Ehrt U, Emre M, De Deyn PP, Wesnes K, Tekin S, Aarsland D: Attentional deficits affect activities of daily living in dementia associated with PD. J Neurol Neurosurg Psychiatry 2006;77:1136–1142.
  7. Mohr E, Walker D, Randolph C, Sampson M, Mendis T: The utility of clinical trial batteries in the measurement of Alzheimer’s and Huntington’s dementia. Int Psychogeriatr 1996;8:397–411.
  8. Walker MP, Ayre GA, Cummings JL, Wesnes K, McKeith IG, O’Brien JT, Ballard CG: Quantifying fluctuation in dementia with Lewy bodies, Alzheimer’s disease and vascular dementia. Neurology 2000;54:1616–1625.
  9. Zaffalon M, Wesnes K, Petrini O: Reliable diagnosis of dementia by the naïve credal classifier inferred from incomplete cognitive data. Artif Intell Med 2003;29:61–79.
  10. Wesnes K: The role of attention deficits in the cognitive pathology of dementia. Alzheimer Insights 2001;7:1–4.
  11. Vellas B, Cunha L, Gertz HJ, De Deyn PP, Wesnes K, Hammond G, Schwalen S: Early onset effects of galantamine treatment on attention in patients with Alzheimer’s disease. Curr Med Res Opin 2005;21:1423–1429.
  12. McKeith I, Del Ser T, Spano P, Emre M, Wesnes K, Anand R, Cicin-Sain A, Ferrara R, Spiegel R: Efficacy of rivastigmine in dementia with Lewy bodies: a randomised, double-blind, placebo-controlled international study. Lancet 2000;356:2031–2036.
  13. Emre M, Aarsland D, Albanese A, et al: Rivastigmine for dementia associated with Parkinson’s disease. N Engl J Med 2004; 351:2509–2518.
  14. Wesnes KA, McKeith IG, Edgar C, Ferrara R, Emre M, Lane R: Benefits of rivastigmine on attention in dementia associated with Parkinson disease. Neurology 2005;65:1654–1656.
  15. Rowan E, McKeith IG, Saxby BK, Newby, Daniel S, Sanders J, Wesnes KA: Effects of donepezil on central processing speed and attentional measures in Parkinson’s disease with dementia and dementia with Lewy bodies. Dement Geriatr Cogn Disord 2007;23:161–167.
  16. Cummings JL: Commentary, cholinesterase inhibitors: expanding applications. Lancet 2000;356:2024–2036.
  17. Press DZ: Parkinson’s disease dementia – A first step? N Engl J Med 2004;351:2547–2549.

 goto top of outline Author Contacts

Prof. Keith A Wesnes, PhD
Cognitive Drug Research Ltd., CDR House
Gatehampton Road
Goring-on-Thames RG8 0EN (UK)
Tel. + 44 1491 878 700, Fax +44 1491 878 701, E-Mail keithw@cognitivedrugresearch.com


 goto top of outline Article Information

Published online: March 6, 2008
Number of Print Pages : 3
Number of Figures : 0, Number of Tables : 0, Number of References : 17


 goto top of outline Publication Details

Neurodegenerative Diseases

Vol. 5, No. 3-4, Year 2008 (Cover Date: March 2008)

Journal Editor: Nitsch R.M. (Zürich), Hock C. (Zürich)
ISSN: 1660–2854 (Print), eISSN: 1660–2862 (Online)

For additional information: http://www.karger.com/NDD


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

This paper considers the suitability of the Alzheimer’s Disease Assessment Scale – Cognitive Subscale (ADAS-cog) as the gold standard in registration trials of treatments for Alzheimer’s disease. Working groups have recommended replacing the ADAS-cog if suitable automated alternatives can be found. This paper makes the case for the Cognitive Drug Research (CDR) computerised cognitive assessment system, as an example of a suitable instrument to replace the ADAS-cog. The CDR system has been widely used in dementia work for 20 years and shows good correlations to the ADAS-cog, while additionally assessing the domains of attention, working memory, information processing and retrieval speed of information held in memory. The utility of the system in evaluating and differentiating the major dementias will be described, as well as its ability to track deterioration over time. Its validation as a core measure of cognitive dysfunction in the dementias will be described, as will work showing that various CDR measures relate closely to activities of daily living. The sensitivity of the CDR system to anticholinesterases will be described in Alzheimer’s disease, dementia with Lewy bodies and Parkinson’s dementia. Finally, the CDR system has a large normative database which allows treatment effects in dementia to be put into an unambiguous clinical perspective.



 goto top of outline Author Contacts

Prof. Keith A Wesnes, PhD
Cognitive Drug Research Ltd., CDR House
Gatehampton Road
Goring-on-Thames RG8 0EN (UK)
Tel. + 44 1491 878 700, Fax +44 1491 878 701, E-Mail keithw@cognitivedrugresearch.com


 goto top of outline Article Information

Published online: March 6, 2008
Number of Print Pages : 3
Number of Figures : 0, Number of Tables : 0, Number of References : 17


 goto top of outline Publication Details

Neurodegenerative Diseases

Vol. 5, No. 3-4, Year 2008 (Cover Date: March 2008)

Journal Editor: Nitsch R.M. (Zürich), Hock C. (Zürich)
ISSN: 1660–2854 (Print), eISSN: 1660–2862 (Online)

For additional information: http://www.karger.com/NDD


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Wesnes K, Harrison J: The evaluation of cognitive function in the dementias: methodological and regulatory considerations. Dialogues Clin Neurosci 2003;5:77–88.
  2. Ferris S, Lucca U, Mohs R, Dubois B, Wesnes K, Erzigkeit H, Geldmacher D, Bodick N: Objective psychometric tests in clinical trials of dementia drugs. Position paper from the International Working Group on Harmonization of Dementia Drug Guidelines. Alzheimer Dis Assoc Disord 1997;11(suppl 3):34–38.

    External Resources

  3. Simpson PM, Surmon DJ, Wesnes KA, Wilcock GK: The Cognitive Drug Research computerised assessment system for demented patients: a validation study. Int J Geriatr Psychiatry 1991;6:95–102.

    External Resources

  4. Wesnes KA, McKeith IG, Ferrara R, Emre M, Del Ser T, Spano PF, Cicin-Sain A, Anand R, Spiegel R: Effects of rivastigmine on cognitive function in dementia with Lewy bodies: a randomised placebo-controlled international study using the Cognitive Drug Research computerised assessment system. Dement Geriatr Cogn Disord 2002;13:183–192.
  5. Wesnes KA, Harrison J, Edgar C, Pincock C: The sensitivity and reliability of the Cognitive Drug Research computerised cognitive assessment system to disease progression and treatment response in Alzheimer’s disease. Int Psychogeriatr 2005;17(suppl 2):154.
  6. Bronnick K, Ehrt U, Emre M, De Deyn PP, Wesnes K, Tekin S, Aarsland D: Attentional deficits affect activities of daily living in dementia associated with PD. J Neurol Neurosurg Psychiatry 2006;77:1136–1142.
  7. Mohr E, Walker D, Randolph C, Sampson M, Mendis T: The utility of clinical trial batteries in the measurement of Alzheimer’s and Huntington’s dementia. Int Psychogeriatr 1996;8:397–411.
  8. Walker MP, Ayre GA, Cummings JL, Wesnes K, McKeith IG, O’Brien JT, Ballard CG: Quantifying fluctuation in dementia with Lewy bodies, Alzheimer’s disease and vascular dementia. Neurology 2000;54:1616–1625.
  9. Zaffalon M, Wesnes K, Petrini O: Reliable diagnosis of dementia by the naïve credal classifier inferred from incomplete cognitive data. Artif Intell Med 2003;29:61–79.
  10. Wesnes K: The role of attention deficits in the cognitive pathology of dementia. Alzheimer Insights 2001;7:1–4.
  11. Vellas B, Cunha L, Gertz HJ, De Deyn PP, Wesnes K, Hammond G, Schwalen S: Early onset effects of galantamine treatment on attention in patients with Alzheimer’s disease. Curr Med Res Opin 2005;21:1423–1429.
  12. McKeith I, Del Ser T, Spano P, Emre M, Wesnes K, Anand R, Cicin-Sain A, Ferrara R, Spiegel R: Efficacy of rivastigmine in dementia with Lewy bodies: a randomised, double-blind, placebo-controlled international study. Lancet 2000;356:2031–2036.
  13. Emre M, Aarsland D, Albanese A, et al: Rivastigmine for dementia associated with Parkinson’s disease. N Engl J Med 2004; 351:2509–2518.
  14. Wesnes KA, McKeith IG, Edgar C, Ferrara R, Emre M, Lane R: Benefits of rivastigmine on attention in dementia associated with Parkinson disease. Neurology 2005;65:1654–1656.
  15. Rowan E, McKeith IG, Saxby BK, Newby, Daniel S, Sanders J, Wesnes KA: Effects of donepezil on central processing speed and attentional measures in Parkinson’s disease with dementia and dementia with Lewy bodies. Dement Geriatr Cogn Disord 2007;23:161–167.
  16. Cummings JL: Commentary, cholinesterase inhibitors: expanding applications. Lancet 2000;356:2024–2036.
  17. Press DZ: Parkinson’s disease dementia – A first step? N Engl J Med 2004;351:2547–2549.