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From the Departments of Neurology (Drs. Galvin and Morris, M.A. Coats and S.J. Muich), Anatomy and Neurobiology (Dr. Galvin), Psychology (Drs. Powlishta and Storandt), and Pathology and Immunology (Dr. Morris) and Division of Biostatistics (Drs. Roe, Grant, and J.P. Miller) and Alzheimer's Disease Research Center, Washington University, St. Louis, MO.
Address correspondence and reprint requests to Dr Galvin, Alzheimer Disease Research Center, Washington University School of Medicine, 4488 Forest Park, Suite 130, St. Louis, MO 63108; e-mail: galvinj{at}neuro.wustl.edu
Background: Brief measures that accurately discriminate normal cognitive aging from very mild dementia are lacking. Cognitive tests often are insensitive to very mild dementia. Informant-based measures may be more sensitive in detecting early dementia.
Objective: To identify informant-reported clinical variables that differentiate cognitively normal individuals from those with very mild dementia.
Methods: A 55-item battery of informant queries regarding an individual's cognitive status was derived from a semistructured interview and a consensus panel of dementia experts. The battery was evaluated with informants for 189 consecutive participants of a longitudinal study of memory and aging and compared with an independently obtained Clinical Dementia Rating (CDR) score for the participant. Multiple regression and receiver operator characteristic curves assessed subsets of the items to discriminate between CDR 0 (no dementia) and CDR 0.5 (very mild dementia).
Results: The final version (AD8) querying memory, orientation, judgment, and function was administered to an additional sample of 112 CDR 0 and 68 CDR 0.5 participants. Using a cut-off of two items endorsed, the area under the curve was 0.834, suggesting good to excellent discrimination, sensitivity was 74%, and specificity was 86% (prevalence of 0.38 for very mild dementia). Inclusion of 56 additional individuals with mild to severe dementia (increasing dementia prevalence to 0.53) increased sensitivity to 85%.
Conclusions: The AD8 is a brief, sensitive measure that reliably differentiates between nondemented and demented individuals. Use of the AD8 in conjunction with a brief assessment of the participant could improve diagnostic accuracy in general practice.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the August 23 issue to find the title link for this article.
Dr. Powlishta's current address is the Department of Psychology, Saint Louis University, St. Louis, MO.
Supported by grants from the National Institute on Aging (K08 AG20764, P01 AG03991, and P50 AG05681), the Longer Life Foundation, the American Federation for Aging Research, and the Alan A. and Edith L. Wolff Charitable Trust. Dr. Galvin is a recipient of the Paul Beeson Physician Faculty-Scholar in Aging Research Award.
Disclosure: The authors report no conflicts of interest.
Received December 13, 2004. Accepted in final form May 4, 2005.
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