New Instruments For Assessing Cognitive Impairment in the Elderly: Implications for Clinical and Epidemiological Studies

1. New Instruments For Assessing Cognitive Impairment in the Elderly: Implications for Clinical and Epidemiological Studies David Loewenstein, PhD Amarilis Acevedo, PhD University of Miami Department of Psychiatry and Neurology Wien Center for Alzheimer�s Disease and Memory Disorders

2. Requirements of Neuropsychological Assessment in Longitudinal Clinical Studies Must tap suitable cognitive domains (e.g.,memory, language,executive function) Must have suitable reliability and validity Must be appropriate in assessing change longitudinally

3. Neuropsychological Assessment in Epidemiological Studies Must capture the most robust and important effects in the briefest period of time (cost-effective) Provide sufficient information for intended purpose (inclusion versus exclusion of subjects, the need for further testing, provide information necessary for the diagnostic process)

4. Issues with Commonly Used Neuropsychological Tests Subtle cognitive changes may occur years before a clinical diagnosis of MCI or dementia Many neuropsychological measures developed for head injury and used with dementia subjects - not developed to be used with MCI or pre-MCI conditions

5. Hallmark Feature of Medial Temporal Lobe Deficits Deficits in Delayed Recall and Rate of Forgetting Newer Findings in AD (Inability to Profit From Cues at Acquisition and Retrieval- Buschke, 1999;2002) Vulnerability to Proactive and Retroactive Semantic Interference Loewenstein and Acevedo,2003; 2004)

6. Some Limitations of Cognitive Measures Level of Educational Attainment Cultural/Language Bias Subject Does Not Serve as Own Control (Age Adjusted Norms Used) Does not Tap Cognitive Processes that Parallel Real-World Deficits (e.g., prospective memory - (remembering to remember intended actions)

7. FLORIDA BRIEF MEMORY SCALES (PART 1) (Loewenstein and Acevedo et. al., 2009) Subjects Told that they Will Be Presented With 15 Targets on List A (which will be fruits, musical instruments or clothing) This Produces an explicit Organizational Strategy To Encode To Be Remembered Targets Subjects Recall Targets Approximately 3 Minutes Administration Time

8. FLORIDA BRIEF MEMORY SCALES (PART 2) (Loewenstein and Acevedo et. al., 2009) Cued Recall for 15 items on List A An additional Presentation of the 15 Items With Cued Recall Presentation of New List B - 15 items sharing the Same 3 Semantic Categories with List A Free Recall of List B (Vulnerable to Proactive Interference) Cued Recall of List B (Vulnerable to Proactive Interference)

9. Advantages of Such a Paradigm Evaluates Initial Recall Strength (subject can serve as own control) Uses Targets that are Simple and Culturally Fair Evaluates Both The Ability To Benefit From Semantic Cues and Susceptibility to Semantic Interference

10. Sensitivity and Specificity of FBMS Free Recall A