Demographically adjusted Rey-Osterrieth Complex Figure Test norms in a Swedish and Norwegian cohort aged 49-77 years and comparison with North American norms.

INTRODUCTION: The Rey-Osterrieth Complex Figure Test (RCFT) is one of the most commonly used neuropsychological tests in Sweden and Norway. However, no publications provide normative data for this population. The objective of this study was to present demographically adjusted norms for a Swedish and Norwegian population and to evaluate these in an independent comparison group. METHODS: The RCFT was administrated to 344 healthy controls recruited from the Swedish Gothenburg MCI study, the Norwegian Dementia Disease Initiation study, and the Swedish Cardiopulmonary Bioimage Study. Age ranged from 49 to 77 years (mean = 62.4 years, SD = 5.0 years), and education ranged from 6 to 24 years (mean = 13.3 years, SD = 3.0 years). Using a regression-based procedure, we investigated the effects of age, sex, and years of education on test performance. We compared and evaluated our Swedish and Norwegian norms with North American norms in an independent comparison group of 145 individuals. RESULTS: In healthy controls, age and education were associated with performance on the RCFT. When comparing normative RCFT performance in an independent comparison group, North American norms generally overestimated immediate and delayed recall performance. In contrast, our Swedish and Norwegian norms appear to better take into account factors of age and education. CONCLUSIONS: We presented demographically adjusted norms for the RCFT in a Swedish and Norwegian sample. This is the first normative study of the RCFT that presents normative data for this population. In addition, we showed that North American norms might produce inaccurate normative estimations in an independent comparison group.

Neuropsychological Test Performance Among Native and Non-Native Swedes: Second Language Effects.

OBJECTIVE: We aimed to study second language effects on neuropsychological (NP) test performance. METHOD: We administered an NP test battery in Swedish to 322 healthy community dwelling participants, recruited through the Gothenburg Pilot phase of the Swedish CArdioPulmonary BioImage Study (SCAPIS Pilot). All participants were conversationally fluent Swedish speakers (237 native, 85 non-native, mean age 61.1 years). We compared the NP scores of native and non-native participants. We also investigated the influence of (a) age of arrival to Sweden, (b) majority language family of the birth country, and (c) proficiency in Swedish as assessed with a 30 item Boston naming test (BNT). RESULTS: Native speakers obtained better results on all NP tasks with a verbal component, whereas no significant differences were seen on completely nonverbal tasks (Rey complex figure). For non-native speakers, lower age at arrival to Sweden, arrival from a country where Swedish was also spoken, or arrival from a country with a majority language closer to Swedish, were all linked to better NP scores. Dichotomizing by BNT showed that normally-to-highly proficient non-native speakers obtained better scores. CONCLUSIONS: Second language effects may contribute to misclassification of non-native speakers. Assumptions of fluency based on short conversations may be misleading. A proficiency assessment with BNT may improve NP score interpretation among non-native speakers.

Subjective Cognitive Impairment Is a Predominantly Benign Condition in Memory Clinic Patients Followed for 6 Years: The Gothenburg-Oslo MCI Study.

BACKGROUND/AIMS: In the quest for prevention or treatment, there is a need to find early markers for preclinical dementia. This study observed memory clinic patients with subjective cognitive impairment (SCI) and normal cognitive function at baseline. The primary aim was to address SCI as a potential risk factor for cognitive decline. The secondary aim was to address a potential relation between (1) baseline cerebrospinal fluid biomarkers and (2) a decline in memory performance over the first 2 years of follow-up, with a possible cognitive decline after 6 years. METHODS: Eighty-one patients (mean age 61 years) were recruited from university memory clinics and followed up for 6 years. RESULTS: Eighty-six percent of the cohort remained cognitively stable or improved, 9% developed mild cognitive impairment, and only 5% (n = 4) developed dementia. Regression analysis revealed that low levels of Aß42 at baseline and memory decline during the first 2 years predicted dementia. When combined, these variables were associated with a 50% risk of developing dementia. CONCLUSIONS: Cognitive stability for 86% of the cohort suggests that SCI is predominantly a benign condition with regard to neuropathology. The low number of individuals who developed dementia limits the generalizability of the results and discussion of progression factors.

Boston Naming Test automatic credits inflate scores of nonaphasic mild dementia patients.

INTRODUCTION: The Boston Naming Test (BNT), a 60-item test of confrontation naming, may be administered either from Item 1 or Item 30, depending on assumptions of performance. If the BNT is administered from Item 30, 29 automatic credits are given for preceding items, allowing identical norms for either administration. We aimed to compare effects of automatic credits. METHOD: We compared effects of automatic credits in the Gothenburg Mild Cognitive Impairment Study, first between normal controls (n = 23) and patients (n = 259), and then between the same patients grouped by stage of impairment: subjective cognitive impairment (SCI, n = 75), mild cognitive impairment (MCI, n = 117), or mild dementia (n = 67). RESULTS: Automatic credits added to all groups. Both administrations from Item 1 and those from Item 30 discriminated between controls (n = 23) and all patients (n = 259), as well as between the above stages of impairment. However, neither administration discriminated between normal controls and SCI patients. When earned scores were compared, with scores counted from Item 30 plus 29 automatic credits, mild dementia patients on average received a 3.4-credit boost. This equals 82% of the standard deviation of Tallberg's Swedish norms [Brain and Language, 94(1), 19-31 (2005)] or 117% of our normal controls' standard deviation. CONCLUSIONS: In our homogenous material, administration of BNT from Item 30 distinguished between stages of deterioration as well as administration from Item 1. In line with recent literature, we also find BNT results skewed. Thus, for clinical accuracy, we recommend use of cumulative percentages, careful consideration of education and demographic factors, and, most importantly, never to mix forms of administrations with and without automatic credits. While BNT automatic credits diminish accuracy on all levels, they inflate scores significantly for nonaphasic mild dementia patients.

The Gothenburg MCI study: Design and distribution of Alzheimer's disease and subcortical vascular disease diagnoses from baseline to 6-year follow-up.

There is a need for increased nosological knowledge to enable rational trials in Alzheimer's disease (AD) and related disorders. The ongoing Gothenburg mild cognitive impairment (MCI) study is an attempt to conduct longitudinal in-depth phenotyping of patients with different forms and degrees of cognitive impairment using neuropsychological, neuroimaging, and neurochemical tools. Particular attention is paid to the interplay between AD and subcortical vascular disease, the latter representing a disease entity that may cause or contribute to cognitive impairment with an effect size that may be comparable to AD. Of 664 patients enrolled between 1999 and 2013, 195 were diagnosed with subjective cognitive impairment (SCI), 274 with mild cognitive impairment (MCI), and 195 with dementia, at baseline. Of the 195 (29%) patients with dementia at baseline, 81 (42%) had AD, 27 (14%) SVD, 41 (21%) mixed type dementia (=AD + SVD = MixD), and 46 (23%) other etiologies. After 6 years, 292 SCI/MCI patients were eligible for follow-up. Of these 292, 69 (24%) had converted to dementia (29 (42%) AD, 16 (23%) SVD, 15 (22%) MixD, 9 (13%) other etiologies). The study has shown that it is possible to identify not only AD but also incipient and manifest MixD/SVD in a memory clinic setting. These conditions should be taken into account in clinical trials.

Alzheimer's disease--subcortical vascular disease spectrum in a hospital-based setting: Overview of results from the Gothenburg MCI and dementia studies.

The ability to discriminate between Alzheimer's disease (AD), subcortical vascular disease, and other cognitive disorders is crucial for diagnostic purposes and clinical trial outcomes. Patients with primarily subcortical vascular disease are unlikely to benefit from treatments targeting the AD pathogenic mechanisms and vice versa. The Gothenburg mild cognitive impairment (MCI) and dementia studies are prospective, observational, single-center cohort studies suitable for both cross-sectional and longitudinal analysis that outline the cognitive profiles and biomarker characteristics of patients with AD, subcortical vascular disease, and other cognitive disorders. The studies, the first of which started in 1987, comprise inpatients with manifest dementia and patients seeking care for cognitive disorders at an outpatient memory clinic. This article gives an overview of the major published papers (neuropsychological, imaging/physiology, and neurochemical) of the studies including the ongoing Gothenburg MCI study. The main findings suggest that subcortical vascular disease with or without dementia exhibit a characteristic neuropsychological pattern of mental slowness and executive dysfunction and neurochemical deviations typical of white matter changes and disturbed blood-brain barrier function. Our findings may contribute to better healthcare for this underrecognized group of patients. The Gothenburg MCI study has also published papers on multimodal prediction of dementia, and cognitive reserve.

T-Tau is Associated with Objective Memory Decline Over Two Years in Persons Seeking Help for Subjective Cognitive Decline: A Report from the Gothenburg-Oslo MCI Study.

BACKGROUND: There is a need to find very early markers for pre-clinical Alzheimer's disease as interventions early in the disease process are thought to be most effective. OBJECTIVE: The present study aimed to address the potential relation between cerebrospinal fluid (CSF) biomarkers and reduced cognitive function in a relatively young cohort of memory clinic patients with subjective cognitive decline. METHODS: 122 patients (mean age 63 years) with subjective cognitive decline were recruited from two university memory clinics and followed for two years. RESULTS: The main finding was that the subgroup with objective memory decline during the study period had significantly higher T-tau at baseline than the group with improved memory. Baseline CSF variables showed a trend toward more pathological values in the patients with memory decline compared to those who improved or remained stable. The baseline memory score of those who declined was significantly better than the baseline score of those who improved over two years. The general trend for the whole group was improved memory and executive test scores. There were no differences in cognitive scores based on CSF quartiles at baseline, nor were there differences in cognitive outcome for patients with early amnestic mild cognitive impairment versus average cognitive function at baseline. CONCLUSIONS: The main finding that T-tau rather than amyloid-ß was associated with memory decline do not support the prevailing opinion about the chain of events assumed to take place in Alzheimer's disease. In addition, memory decline was not associated with poor baseline memory score. Thus, a memory cut-off indicating low baseline memory would not would have identified the declining group.

An example of exceptional practice effects in the verbal domain.

XY, a 20-year-old mnemonist (current world ranking within the top 50) was tested with standard neuropsychological tests. XY recalled all words on all trials on the Rey Auditory Verbal Learning Test (RAVLT, 15 words) and scored above the 99.9th percentile on the Wechsler Memory Scales R, Logical Memory (WLM, 2 short stories, 25 units per story, 50 units total). XY had not been previously tested with neuropsychological tests, but had trained memory techniques for approximately 8 years. We suggest that training on similar tasks resulted in substantial practice effects in the verbal memory domain, with no measurable transfer effects to the visual domain. In addition to previous findings, we present a practice effect on RAVLT and WLM exceeding previously documented test-retest effects by 2-3 standard deviations.