Sep 5, 2011

Cognitive Changes May Predict Alzheimer’s Disease Development More Accurately

Dotty's behavior changed but no one thought, hmm, Dotty is old and at a high risk for dementia, they thought "she's getting old."

Bob DeMarco
Alzheimer's Reading Room

This research study caught my attention. The researchers report that changes in cognitive ability are stronger predictors of whether an individual with mild cognitive impairment (MCI) will develop Alzheimer's disease (AD) than will changes in biomarkers.

Well, you can't see biomarkers but you can see and detect changes in behavior. I remain convinced that in many cases AD would be detected earlier if families were better educated about the importance behavior change plays in Alzheimer's disease.

Here is what often happens. A person starts acting different. Let's say they were always very nice, then all of a sudden they start to get mean. Or, they start complaining a lot. What is the typical conclusion?

They are getting old.

That is exactly what every one of my friends said, and what Dotty's doctor said, when I first started voicing concerns about her changes in behavior. Ignorance is bliss.

There is a real need for education and awareness on issues like these.

Let's face it. I didn't know any thing either. Dotty had like 20 bottles of salad dressing. Yes, they were all different kinds. So I suppose I deluded myself into to thinking she must like salad dressing. Dotty also had about ten bottles of shampoo. All different brands. I suppose I was thinking, wow, she has every kind of shampoo for when people come to visit.

Dotty had lots of toothpaste, different brands. Lots of toilet paper, mostly same brand. The list goes on and on.

After I moved to Delray Beach to take care of Dotty, I finally figured out what was going on. Dotty and I would go to the grocery store and she would put the same exact things in the basket whether we needed them or not. Salad dressing, toilet paper, and worse, chips and frozen food dinners. The frozen food dinners should have tipped me off.

Other behaviors that no one told me about and that I learned about in the ensuing years. Dotty stopped going to the birthday luncheons with her girlfriends. Well not exactly. They stopped inviting her because she was always complaining. Change in behavior, no one thought, hmm, Dotty is old and at a high risk for dementia, they thought "she's getting old."

Dotty stopped going to the pool, she was no longer working, and she was more or less living in a cave. Nobody noticed.

Of course, her behavior changes, her meanness, and her anger were getting worse slowly but surely.

On the other hand. Dotty was still doing her own shopping. Of course she was eating crap and gained about 30 pounds after she was 80 years old. Dotty was still going to bingo and driving herself home in the dark twice a week. Dotty was still driving.

So Dotty was living a dumbed down, not so great version of her life, and nobody noticed.

She was just getting old.

By the way, Dotty was a decent by slow driver at the age of 87. I think I got here just in the "nick" of time.

What I am describing here is "older onset" dementia. "Younger onset" dementia detection and diagnosis are very different. Why you ask? Because no one assumes that the changes in behavior are a result of "getting old".

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Cognitive Changes May Predict Alzheimer’s Disease Development More Accurately Than Biomarkers

Compared with changes in biomarkers, changes in cognitive abilities appear to be stronger predictors of whether an individual with mild cognitive impairment (MCI) will develop Alzheimer’s disease, according to a report in the September issue of Archives of General Psychiatry.

Biomarkers such as changes in brain volume or in cerebrospinal fluid levels of some proteins have helped scientists learn about how Alzheimer’s disease develops and whether treatments for it are effective, according to background information in the article. Behavioral markers such as cognitive changes, genetic risk factors and demographic variables also seem to be associated with the condition. However, the authors write, “despite formidable evidence for the predictive validity of individual biomarkers and behavioral markers, they have rarely been examined in combined models.”

Jesus J. Gomar, Ph.D., from the Benito Menni Complex Assistencial en Salut Mental, Barcelona, Spain, and colleagues sought to determine how well different classes of biomarkers and cognitive markers could predict whether patients with MCI would develop Alzheimer’s disease. They also wanted to assess whether any of these factors was associated with a disproportionate magnitude of decline. The longitudinal study used information from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. The study included 116 participants with MCI that converted to Alzheimer’s disease in two years, 204 participants with MCI that did not convert to Alzheimer’s disease and 197 cognitively healthy participants as controls.

The researchers used a variety of neuropsychological tests to assess participants’ cognition and ability to function. They obtained cerebrospinal fluid samples when the study began and at annual visits for two years. At the beginning of the study, participants gave a blood sample which was examined for the presence of genes associated with Alzheimer’s disease. The researchers also obtained information about participants’ brain volume and cortical thickness from magnetic resonance imaging results included in the ADNI.

Analysis of the variables showed that two measures of delayed memory, as well as the cortical thickness of the left middle temporal lobe in the brain, were associated with a higher chance of converting from MCI to Alzheimer’s disease at two years. A change in participants’ scores on a measure of functional activities appeared to show a larger rate of decline than did changes in biomarkers. In particular, a decline in scores on the Functional Assessment Questionnaire and the Trail Making Test, part B, appeared to predict whether an individual with MCI would develop Alzheimer’s disease within one year.

“Cognitive markers at baseline were more robust predictors of conversion than most biomarkers,” write the authors. “Longitudinal analyses suggested that conversion appeared to be driven less by changes in the neurobiologic trajectory of the disease than by a sharp decline in functional ability and, to a lesser extent, by declines in executive function.” The researchers add that in clinical practice and in clinical trials, the optimal way to accurately predict conversion to Alzheimer’s disease is to use all available data.
(Arch Gen Psychiatry. 2011;68[9]:961-969. Available pre-embargo to the media at

Editor’s Note: This study was supported by grants from the Litwin-Zucker Alzheimer’s Center and by a grant from Instituto de Salud Carlos III. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Bob DeMarco is the Founder of the Alzheimer's Reading Room and an Alzheimer's caregiver. The blog contains more than 2,910 articles with more than 652,100 links on the Internet. Bob lives in Delray Beach, FL.

Original content Bob DeMarco, the Alzheimer's Reading Room