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Alzheimer's, Dementia & Mental Health
Dementia in Older People Can Be Accurately Predicted
by New Tool
Some surprising risk factors: slim, non-drinkers,
artery bypass, moving slowly, 70 or older, poor cognitive scores
 June 11, 2007 - Researchers say they have developed
a test that can predict a person’s risk for developing dementia within
six years. The test, which can be administered by any physician, has
proven to have an accuracy rate of 87 percent, say researchers at San
Francisco VA Medical Center (SFVAMC).
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The test, developed in the study by the
researchers, is a 14-point index combining medical history, cognitive
testing, and physical examination. It requires no special equipment and
can be given in a clinical setting such as a doctor’s office or at a
patient’s bedside.
The new index is the “bedside” version of a longer,
more technically comprehensive “best” test, also developed during the
study, that is 88 percent accurate.
These are the first tools to accurately predict
dementia, according to lead author Deborah E. Barnes, PhD, a mental
health researcher at SFVAMC. Barnes described the tests in a
presentation at the 2007 International Conference on Prevention of
Dementia, in Washington, DC, sponsored by the Alzheimer’s Association.
“There are tests that accurately predict an
individual’s chances of developing cardiovascular disease and other
maladies, but, until now, no one has developed similar scales for
dementia,” says Barnes, who also is an assistant professor of psychiatry
at the University of California, San Francisco (UCSF).
As measured by the “bedside” index, the risk
factors for developing dementia are -
● an age of 70 or older,
● poor scores on two simple cognitive tests,
● slow physical functioning on everyday tasks such as buttoning a
shirt or walking 15 feet,
● a history of coronary artery bypass surgery,
● a body mass index of less than 18, and
● current non-consumption of alcohol.
People who score 0 to 3 on the “bedside” test have
a 6 percent chance of developing dementia within six years. A score of 4
to 6 indicates a 25 percent chance.
People with a score of 7 or higher have a 54
percent chance of developing dementia within six years.
The 18-point comprehensive, or “best,” test
measures for all “bedside” risk factors plus factors that would be more
difficult to measure as part of a routine clinical visit.
These include brain magnetic resonance imaging
(MRI) findings of enlarged ventricles - the fluid-filled cavities
between brain tissue -- or diseased white matter - the nerve cells that
transmit signals between grey matter; thickening of the internal carotid
artery, which brings blood to the head and neck; and the presence of one
or two copies of the e4 allele, or subtype, of APO-E, the gene that
codes for the protein known as Apolipoprotein.
The presence of APO-E e4 alleles is a known risk
factor for Alzheimer’s disease.
A “best” test score of 0 to 4 indicates a 4 percent
chance of developing dementia within six years. A score of 5 to 8
indicates a 25 percent chance.
A score of 9 or higher indicates a 52 percent
chance of developing dementia within six years.
To develop the tests, the study authors tracked a
broad range of physical, mental, demographic and other variables for six
years among 3,375 participants in the Cardiovascular Health Cognition
Study, a national prospective study sponsored by the National Heart,
Lung, and Blood Institute (NHLBI). At the beginning of the study, none
of the subjects were demented.
Their mean age was 76. Fifty-nine percent were
women and 15 percent were African-American. By the end of the study, 14
percent of the subjects had developed dementia. The variables that were
predictive of dementia in a statistically significant way became the
basis of the tests.
The authors caution that there were no Hispanics or
Asian-Americans included in the study population, and that the new
scales need validation in other study groups before they can become
standard clinical tools.
“We certainly plan to look at other groups to see
if these results are valid across a variety of populations,” says
Barnes.
Editor’s Notes:
Co-authors of the study are Kenneth E. Covinsky,
MD, MPH, of SFVAMC and UCSF; Lewis H. Kuller, MD, DrPH, and Oscar L.
Lopez, MD, of the University of Pittsburgh, Pittsburgh, Penn.; and
Kristine Yaffe, MD, of SFVAMC and UCSF.
The research was funded by a grant from the
National Institute on Aging. SFVAMC has the largest medical research
program in the national VA system, with more than 200 research
scientists, all of whom are faculty members at UCSF.
UCSF is a leading university that advances health
worldwide by conducting advanced biomedical research, educating graduate
students in the life sciences and health professions, and providing
complex patient care.
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