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Daniel Jacobs
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aphasia tests: FAST MAST LAST AACHEN

http://strokengine.ca/assess/module_fast_intro-en.html

 

http://www.tbims.org/combi/mast/mastrat.html

MoCA norms

Subtract one for education < 12 years

Per paper, even with education adjusted corrections to score, 62 % fell below suggested cut scores.  The scores above are suggested alternative cut scores that are lower based on education.  Neurology 2011

Specific white matter lesions and specific neuropsychological deficits

Behavioral neurology 2.0 of white matter
Smith EE et al.  Correlations between MRI white matter lesion location and executive function and episodic memory.  Neurology 2011; 76:1492-1499.

Elderly patients (n=160, 147 analyzed) who were 65+ with mild cognitive impairment underwent a 22 item neuropsychological test . 

Areas associated with decline in executive function score:  bilateral inferior frontal lobe white matter (uncinate fasciculus), inferior longitudinal fasciculus and superior longitudinal fasciculus,
cingulum bindle, bundle of Muratoff on left. 

Comment-- as with prior lesion studies in MRI one wonders about radiology technique, ie what about NAWM (normal appearing white matter) and whether this technique captures the anatomy of the disease.  Still its a well done study that captures the imagination for behavioral neurology 2.0, behavioral neurology of the white matter.

Frontal lobe questionnaires links FAB EXIT DKEFS NPI FBI

FAB  Frontal Assessment Battery- www.stvincents.ie/dynamic/File/Frontal%20Assessment%20Battery_SVUH_MedEl_tool.doc

EXIT  Executive Interview www.dementia-assessment.com.au/frontotemporal/EXIT25_Executive_Interview.pdf

D-KEFS Delis-Kaplan Executive Function Test http://www.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=015-8091-108&Mode=summary

NPI  Neuropsych Inventory (and variant forms) http://npitest.net/download.html

FBI Frontal behavior inventory http://www.chumneurologie.org/conferences/FBI/FBI.pdf

Neuropsych abnormalities in pre-HD

from Duff et al.  Neurology 2010; 75:500-507

 

Authors found linear trends with SDMT affected first, then episodic memory (trial four or delay trial of HVLT, with facial recognition less affected and Color Trails less affected. Authors used raw scores, and found most patients had nonamnestic MCI in a single domain, not multiple domain.  Conclusion was that these tests are important markers for future trials of neuroprotection.

ADC Uniform Dataset (UDS): The Neuropsychologic test battery

Minimum data set in making for over ten years.  A spanish version of the UDS is available at https://www.alz.washington.edu.  Standard scoring is available at UDS Guidebook and Appendix, and later Neuropsychological Test Instructions, distributed to ADC's.  Version 2 differs in that logical memory story 2 delayed recall is done at 20 not 30 minutes with cueing with one detail from story now given.  Visuospatial measures were not used.  Focus of initial battery was Attention, speed of processing, executive function, episodic memory, and language.  Tests were selected by the panel with comments.  Tests utilized, with mean, sd, Q25, Q75, median and range for normals indicated:

 

1.  MMSE with a separate score for orientation out of ten -- note that its insensitive for dementia but is useful to tag milestones once dementia is established.  MMSE 29,1.3, 28, 30, 29, 17-20; Orientation items only: 9.7, 0.9, 10,10,10, 0-10.

 

2.  Digit Span Test from WMS -R, with 2 scores derived, namely total trials and longest digit sequence reproduced.

Digit span forward total trials:  8.6,2.1, 7,10,9, 1-12.

Digit span forward longest sequence:  6.7, 1.1, 6,8, 7, 0-8.

Digit span backwards total trials:  6.9, 2.2, 5,8,7,-12

Digit span backwards longest sequence: 5, 1.2, 4,6,5,1-7

 

3.  Trailmaking Test Parts A and B with standard rules but time limits of 150 seconds for Part A and 300 seconds for Part B. 

 

Part A Time in seconds:  34.6, 15.4, 25,40,31, 11-150.

Part B in seconds:  90.3, 50, 59, 105, 10-300

4.  Digit Symbol Coding from WAIS-R standard, with the score the total number of items completed in 90 seconds. Usually WMS R was used.

 

5. Logical memory stories--Immediate recall, and delayed recall. Test required at least 20 minute delay for delayed recall with notation of amount of time used for the delay.  Cue was given for second story. 

 

logical memory A total units, immediate recall  13.9 , 3.9, 11,17,14, 0-25

logical memory A delayed recall  12.6, 4.3, 10,16,13, 0-25

 

6.  Word lists were not used due to variability in implementation but centers were encouraged to use one and study its relationship to logical memory stories.

 

7.  Boston Naming Test short version using odd items, with discontinuation after six consecutive failures.  The score was the number named within a 20 second time limit plus the number named correctly with a semantic cue. 

 

27.2 , 3.2, 26, 29, 28, 2-30

 

8.  Verbal fluency was assessed using animal and vegetable list generation in one minute.

 

animals in 60 seconds:  20 , 5.6, 16,24, 20, 1-54

vegetable:  14.7, 4.4, 12,17,15,1-63.

 

9.  Additional items used:  FAQ (functional assessment questionnaire), behavioral symptoms from NPI-Q short form), and Geriatric Depression Scale. 

 

10.Inability to respond due to physical barriers was noted.

The non public domain items (most of test) were given in cooperation with manufacturers and consent.  Entire battery required 3-40 minutes was given annually.  Paper gives normal values.  Ceiling effects were obtained with perfect or nearly perfect scores on digit span forward and backwards (cannot exceed 8 and 7 respectively), BNT, MMSE orientation score, and total score.  On other tests some outlier scores were found (584/3268 had one or two outlier scores, 61 had 3 or more). 

 

 

Age, sex and education (demographics) were associated with nearly all results.  Males and females differed on more than half of test results.    Future tests will take into account additional qualitative information such as number of incorrect lines on the TMT.  Longitudinal studies will help separate abnormal from peak performance