Early detection of Alzheimer's disease: Improvement of neuropsychological screening
7 September 2018
UAntwerp, Campus Drie Eiken, Building O, Auditorium O3 - Universiteitsplein 1 - 2610 Wilrijk (Antwerpen) (route: UAntwerpen, Campus Drie Eiken
5:00 PM - 7:00 PM
Ellen De Roeck
Sebastiaan Engelborghs, Peter Paul De Deyn, Eva Dierckx
PhD defence Ellen De Roeck - Department of Biomedical Sciences
In the light of early detection of Alzheimer’s disease (AD) neuropsychological instruments are an important subject to study. They are non-invasive, frequently used in everyday clinical practice and are essential in all the AD phases. The goal of this thesis is to improve the detection of AD with neuropsychological instruments trough the different phases of the AD continuum. In the first part, entitled cognitive frailty we explored how subjective cognitive decline (SCD) could be detected in community-dwelling older adults. Therefore we added four self-reported questions that represent cognitive frailty, to the Comprehensive Frailty Assessment Instrument (CFAI), resulting in the CFAI-plus.
The CFAI-plus is an easy-to-administer tool for the identification of individuals with multidimensional frailty in the general older population and can be used as a first step for screening programs. In the second part that dealt with cognitive screening instruments, we focused on how we can detect mild cognitive impairment (MCI) due to AD in older adults. With a systematic review we showed that despite the large number of available instruments (n=50), none of the instruments has the ideal psychometric properties to detect MCI due to AD. However based on the review, the MoCA would be a good screening in case its specificity could be improved.
Therefore we modified the MoCA to improve its specifity. In comparison with the original MoCA, the modified MoCA showed improved sensitivity and specificity for MCI due to AD and was able to significantly predict conversion from MCI to (AD) dementia. We therefore concluded that the modified MoCA can be used to detect MCI (due to AD). In the third part about neuropsychiatric symptoms we studied the role of depressive symptoms and apathy in the conversion from MCI to (AD) dementia. In a first study we showed that depressive symptoms, could not predict conversion from MCI to (AD) dementia after 1.5, 4, and 10 years of follow-up. In a second study we found that apathy could predict conversion from MCI to (AD) dementia after 1 year of follow-Up. Our findings suggest that depressive symptoms and apathy occur at different moments in the AD continuum. The different studies discussed in this thesis underline the importance and usefulness of neuropsychological screening instruments for the early detection of AD. This PhD study also emphasizes the importance of longitudinal research and to combine neuropsychological findings with biomarker-based diagnoses in future studies.