Four Questions on Simple Questionnaire Found Highly Predictive of Mild Cognitive Impairment & Risk of Alzheimer's

By Editor, on February 4th, 2012

Questionnaire Identifies Mild Cognitive Impairment, Early Predictor of Alzheimers A new study published on February 3, 2012 in the journal BMC Geriatrics has found four questions on a simple 21-question Alzheimer’s Questionnaire given to family members or caregivers of a patient to be highly accurate in identifying Mild Cognitive Impairment (MCI) of the patient, which is a known predictor of Alzheimer’s Disease.

Early identification of MCI is important in order to allow early preventive measures to be implemented which may help slow or avoid the development of Alzheimer’s Disease, according to the researchers.

Some sources indicate that up to 15 percent of people with MCI develop Alzheimer’s within one year. However, studies have shown that preventive interventions such as exercise and changes in lifestyle factors can be effective in staving off mental decline. See below.

The new study found that four questions on the 21-question Alzheimer’s Questionnaire were most highly predictive of MCI. These questions, ordered from most predictive to least predictive of MCI, are:

“Does the patient frequently have trouble knowing the day, date, month, year, and time; or does the patient reference a newspaper or calendar for the date more than once a day?

Does the patient repeat questions or statements or stories in the same day?

Excluding physical limitations, does the patient have trouble paying bills or doing finances; or are family members taking over because of concerns about ability?

Does the patient have a decreased sense of direction?“

The new study, “Informant-reported cognitive symptoms that predict amnestic mild cognitive impairment,” by Michael Malek-Ahmadi, MSPH, and colleagues from the Banner Sun Health Research Institute in Sun City, Arizona, is published in the February 3, 2012 issue of the journal BMC Geriatrics.

Background

The authors of the new study had previously developed the 21-question Alzheimer’s Questionnaire (AQ) in an effort to provide a simple and reliable means to assist clinicians in identifying potential cases of Mild Cognitive Impairment (MCI) by asking questions to the patients’ family members or caregivers accompanying them.

The authors previously conducted a more extensive study testing the reliability of their 21-question Alzheimer’s Questionnaire in identifying cases of MCI and Alzheimer’s Disease. Their earlier study found the Questionnaire to be highly sensitive and specifically capable of detecting both MCI and Alzheimer’s. The earlier study, “The Alzheimer’s Questionnaire: A Proof of Concept Study for a New Informant-Based Dementia Assessment,” was published in 2010 in the Journal Alzheimers Disease, and is available in its entirety online from PubMed, a resource for published medical research provided by the National Institutes of Health.

The entire 21-question Alzheimer’s Questionnaire and its scoring is found in Appendix 1 of the authors’ previous study.

The authors explain that they developed the Alzheimer’s Questionnaire based on previously known scientific indicators of MCI and Alzheimer’s. The Questionnaire consists of 21 simple “yes” or “no” questions to be asked of the caregiver or family member of the patient. Each “yes” answer is scored as one point on all but six of the questions. On those six questions, a “yes” answer is scored as two points. These six questions were weighted doubly “based on their ability to accurately predict the clinical AD [Alzheimer's Disease] diagnosis which is made based on the results from other validated instruments,” according to the authors.

The authors indicate that a score of 15 or higher on the Questionnaire suggests Alzheimer’s Disease, a score between five and 14 suggests Mild Cognitive Impairment (MCI), while a score of four or lower indicates normal cognitive functioning.

In their earlier study, the authors wrote, “Evidence suggests that physicians, bombarded by demands of care by increasing numbers of medical conditions and available treatments, are not sufficiently sensitive to signs of cognitive impairment or early dementia.” “Delaying diagnosis results in increased likelihood of disease progression before intervention is attempted.”

“We have developed the Alzheimer’s Questionnaire (AQ), a clinician-administered and informant-based screening instrument as a way to quickly and accurately detect cognitive impairment,” the authors explained. “This will aid clinicians in asking the most pertinent questions when screening for cognitive decline in the primary care setting.”

In discussions and conclusions published in their new study, the authors wrote:

“For clinicians who see patients with subjective memory complaints, accurate identification of those who need further evaluation is critical to cost containment and resource management. A significant proportion of older adults present with subjective memory complaints, and these complaints can precede the onset of clinical AD. The large and growing number of older adults underscores the importance of utilizing brief and accurate screening measures. Additionally, as new therapies for AD transition from being symptomatic to disease-modifying, identifying individuals who are at-risk or are in the earliest stages of the disease will be crucial in determining and improving disease outcome.”

New Study; Methodology

In their new study, the authors sought to determine more specifically which items on their Alzheimer’s Questionnaire are most predictive of amnestic Mild Cognitive Impairment (aMCI).

Their new study included 51 cognitively normal participants and 47 individuals diagnosed as having Mild Cognitive Impairment. The participants had been identified and diagnosed as cognitively normal or having Mild Cognitive Impairment by a consensus of clinicians, neurologists, geriatric psychiatrists, and other experts at the authors’ institution, based on known psychological and medical tests.

Persons with “symptomatic or severe brain-related neurological or psychiatric illness” were specifically excluded from the study sample, based on a review of medical records and interviews with the participants and their participating family member or caregiver (whom the researchers termed the “informant”).

The 21-question Alzheimer’s Questionnaire was administered by clinicians to the informants of the study participants. The researchers performed statistical analysis on the results to determine how well individual items on the Alzheimer’s Questionnaire were able correctly to identify the cases of MCI among the study participants.

Findings

The researchers found that the four questions identified at the beginning of this article above were most predictive of MCI.

They reported that patients reported to have trouble remembering the day, month, year, and time of day were found to be almost 18 times more likely to have amnestic Mild Cognitive Impairment than the cognitively normal patients (OR 17.97, 95% CI 2.63 to 122.77, P=0.003).

Those who were reported to have often repeated questions, statements and stories on the same day were 13 times more likely to have MCI (OR 13.12, 95% CI 3.02 to 57.66, P=0.001), while those who, excluding physical limitations, had trouble paying bills or doing finances were almost 12 times more likely to have MCI (OR 11.60, 95% CI 2.10 to 63.99, p=0.005), and those reported to have a decreased sense of direction were almost 6 times more likely to have MCI (OR 5.84, 95% CI 1.09 to 31.30, p=0.04), the researchers reported.

Conclusions

“Overall, the results of this study indicate that certain AQ [Alzheimer's Questionnaire] items can differentiate individuals with aMCI from those experiencing age-associated changes in memory and cognition. As assessed by the AQ, difficulties with orientation to time, repetition of questions and statements, difficulties in managing finances, and visuospatial disorientation were all significant predictors of aMCI as diagnosed by an expert in memory disorders,” the authors concluded.

The authors did indicate that their Questionnaire and the results of this study require further validation by further studies. As potential weaknesses in their study, they mentioned that “a larger sample size might provide a more accurate estimate of effect,” and that their “study sample was homogenous with respect to ethnicity, as all subjects were Caucasian, so it is unclear whether these results are applicable to an ethnically diverse population.”

As to the significance of their findings and their Questionnaire, the authors wrote, “Given that memory complaints are commonly reported by elderly patients and their family members, a means to quickly and accurately identify individuals who may be in the early stages of AD and in need of further evaluation is critical to not only cost containment and resource management, but also to earlier diagnosis in order to improve disease outcome.”

“These data indicate that problems with orientation to time, repeating statements and questions, difficulty managing finances, and trouble with visusospatial orientation may accompany memory deficits in aMCI. From a clinical standpoint, these findings are important as it will allow clinicians to more easily and accurately determine which individuals require further assessment of cognitive problems,” the authors concluded.

More Information

A free provisional PDF copy of the new study, “Informant-reported cognitive symptoms that predict amnestic mild cognitive impairment,” in its entirety is available online from the publisher BMC Geriatrics.

See related HelpingYouCare™ reports on:

New Guidelines for Diagnosis of Alzheimer’s (discussing also the new clinical guidelines developed for diagnosing Mild Cognitive Impairment);

Weight Loss and Walking Exercise Improve Memory, Studies Find;

Regular Exercise Slows Mental Decline With Aging, Studies Find; May Make You Cognitively Younger by 5 to 7 Years;

Half of Alzheimer’s Cases Attributable to 7 Risk Factors Preventable by Lifestyle Changes, Study Finds.

For more information on Alzheimer’s and dementia, see the HelpingYouCare™ resource pages on Alzheimer’s/ Dementia, including: