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.
© 2008 S. Karger AG, Basel
- The Cognitive Drug Research system
- Alzheimer’s Disease Assessment Scale – Cognitive Subscale
- Alzheimer’s disease
- Dementia with Lewy bodies
- Parkinson’s dementia
- Wesnes K, Harrison J: The evaluation of cognitive function in the dementias: methodological and regulatory considerations. Dialogues Clin Neurosci 2003;5:77–88.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Wesnes K: The role of attention deficits in the cognitive pathology of dementia. Alzheimer Insights 2001;7:1–4.
- 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.
- 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.
- Emre M, Aarsland D, Albanese A, et al: Rivastigmine for dementia associated with Parkinson’s disease. N Engl J Med 2004; 351:2509–2518.
- 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.
- 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.
- Cummings JL: Commentary, cholinesterase inhibitors: expanding applications. Lancet 2000;356:2024–2036.
- Press DZ: Parkinson’s disease dementia – A first step? N Engl J Med 2004;351:2547–2549.
Prof. Keith A Wesnes, PhD
Cognitive Drug Research Ltd., CDR House
Goring-on-Thames RG8 0EN (UK)
Tel. + 44 1491 878 700, Fax +44 1491 878 701, E-Mail email@example.com
Published online: March 6, 2008
Number of Print Pages : 3
Number of Figures : 0, Number of Tables : 0, Number of References : 17
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
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