Alzheimer Disease: Massman PJ

Davis RN, Massman PJ, Doody RS. · Department of Psychology, University of Houston, USA. · Psychol Aging. · Pubmed #14692868 No free full text.

Abstract: The WAIS-R is often used in neuropsychological evaluations of individuals with probable Alzheimer's disease (AD), but its factor structure in this population is unknown. Moreover, theories and past research findings make competing predictions concerning its structure. Using confirmatory factor analysis, the authors compared 5 alternative WAIS-R factor models among 516 AD patients: 1-factor (Spearman's g) and 2-factor (Verbal IQ and Performance IQ) models; a 3-factor model including Verbal Comprehension (VC), Perceptual Organization (PO), and Freedom From Distractibility (FD) factors; a 3-factor model in which Digit Symbol loads on PO rather than FD; and a 3-factor model in which Digit Symbol loads on both PO and FD. Results favored the 3-factor model in which Digit Symbol loads on PO rather than FD. Moreover, this model fit the data best among subsamples of patients defined by age, dementia severity, years of education, and gender.

Davis RN, Massman PJ, Doody RS. · Department of Psychology, University of Houston, Texas 77204-5341, USA. · Alzheimer Dis Assoc Disord. · Pubmed #11236819 No free full text.

Abstract: The efficacy of a cognitive intervention consisting of training in face-name associations, spaced retrieval, and cognitive stimulation was tested in a sample of 37 patients (16 men, 21 women) with probable Alzheimer disease (AD). Patients with AD were randomly assigned to receive either the cognitive intervention or a mock (placebo) intervention for 5 weeks. The placebo group then crossed over to receive the intervention. During the intervention, AD patients showed significant improvement in recall of personal information, face-name recall, and performance on the Verbal Series Attention Test. Improvement did not generalize to additional neuropsychologic measures of dementia severity, verbal memory, visual memory, word generation, or motor speed, or to caregiver-assessed patient quality of life. Results suggest that although face-name training, spaced retrieval, and cognitive stimulation may produce small gains in learning personal information and on a measure of attention, improvement does not generalize to overall neuropsychologic functioning or patient quality of life.

O'Bryant SE, Waring SC, Cullum CM, Hall J, Lacritz L, Massman PJ, Lupo PJ, Reisch JS, Doody R, Anonymous00335. · Department of Neuropsychiatry and Behavioral Science, Texas Tech University Health Sciences Center, 3601 4th St, STOP 8321, Lubbock, TX 79430, USA. · Arch Neurol. · Pubmed #18695059 links to  free full text

Abstract: BACKGROUND: The Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB) score is commonly used, although the utility regarding this score in staging dementia severity is not well established. OBJECTIVE: To investigate the effectiveness of CDR-SOB scores in staging dementia severity compared with the global CDR score. DESIGN: Retrospective study. SETTING: Texas Alzheimer's Research Consortium minimum data set cohort. PARTICIPANTS: A total of 1577 participants (110 controls, 202 patients with mild cognitive impairment, and 1265 patients with probable Alzheimer disease) were available for analysis. MAIN OUTCOME MEASURES: Receiver operating characteristic curves were generated from a derivation sample to determine optimal cutoff scores and ranges, which were then applied to the validation sample. RESULTS: Optimal ranges of CDR-SOB scores corresponding to the global CDR scores were 0.5 to 4.0 for a global score of 0.5, 4.5 to 9.0 for a global score of 1.0, 9.5 to 15.5 for a global score of 2.0, and 16.0 to 18.0 for a global score of 3.0. When applied to the validation sample, kappa scores ranged from 0.86 to 0.94 (P < .001 for all), with 93.0% of the participants falling within the new staging categories. CONCLUSIONS: The CDR-SOB score compares well with the global CDR score for dementia staging. Owing to the increased range of values, the CDR-SOB score offers several advantages over the global score, including increased utility in tracking changes within and between stages of dementia severity. Interpretive guidelines for CDR-SOB scores are provided.

Atchison TB, Massman PJ, Doody RS. · Department of Psychology, Sociology, and Social Work, West Texas A&M University, Box 60296, Canyon, TX 79016-0001, United States. · Arch Clin Neuropsychol. · Pubmed #17174522 No free full text.

Abstract: Decline in basic self-care abilities is an important risk factor for institutionalization in individuals with dementia. The ability to predict such decline would be of clinical importance in working with families of dementia patients. Research has suggested that cognitive decline may precede loss of functional capacity. This paper utilized a large sample of probable Alzheimer's disease patients (N=150) who were evaluated longitudinally to assess the pattern of neuropsychological functioning predictive of rapid decline in self-care. The findings indicated that despite initial equality of Lawton Physical Self-Maintenance (PSM) scores, patients showing rapid decline of PSM function displayed significantly more impaired performance on neuropsychological measures at diagnosis. They also exhibited a statistically significant difference in the pattern of scores from patients who remained stable. The pattern of the rapid declining group included more severe impairment in visual spatial skills, processing speed, and concept formation. Difficulties in using individual patients' cognitive profiles to make predictions about future rate of PSM decline are discussed.

Pavlik VN, Doody RS, Massman PJ, Chan W. · Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77098-3926, USA. · Dement Geriatr Cogn Disord. · Pubmed #16954693 No free full text.

Abstract: BACKGROUND: Lower education is associated with a higher risk of developing Alzheimer's disease (AD). Years of education and measures of general intellectual function (IQ) are highly correlated. It is important to determine whether there is a relationship between education and AD outcomes that is independent of IQ. OBJECTIVE: To test the hypothesis that premorbid IQ is a stronger predictor of cognitive decline, global progression, and overall survival, than education in patients with AD. METHODS: The study included 478 probable AD patients (322 women and 156 men, mean age 74.5 years) followed in a large AD referral center for a mean of 3.2 years. Eligible participants had a baseline estimate of premorbid IQ using the American version of the Nelson Adult Reading Test (AMNART) and at least one follow-up visit with complete neuropsychological assessment. We used random effects linear regression analysis, and Cox proportional hazards analysis to determine whether or not education and/or premorbid IQ were independently associated with cognitive decline, global progression of AD, and survival. RESULTS: When the baseline AMNART score was included in regression models along with education and other demographic variables, AMNART score, but not education, was associated with a higher baseline score and slower rate of decline in MMSE and ADAS-Cog scores, and the Clinical Dementia Rating sum of boxes score. Neither higher premorbid IQ nor higher education was associated with longer survival. CONCLUSIONS: We conclude that a baseline AMNART score is a better predictor of cognitive change in AD than education, but neither variable is associated with survival after diagnosis.

Waring SC, Doody RS, Pavlik VN, Massman PJ, Chan W. · Division of Epidemiology, University of Texas School of Public Health, Houston, TX 77030, USA. · Alzheimer Dis Assoc Disord. · Pubmed #16327343 No free full text.

Abstract: Survival among patients with dementia is critical information needed for planning and assessing the overall impact of dementia. Attrition from longitudinal cohorts often limits the confidence in survival estimates. For this study, we examined survival among dementia patients from a large multi-ethnic population with excellent longitudinal follow-up. Subjects were all Baylor Alzheimer's Disease Center patients residing in the greater Houston area at the time of initial diagnosis. Vital status was available for all subjects. We estimated median survival time (Kaplan-Meier) from first symptom onset and from diagnosis, and examined the effects of baseline patient characteristics on survival. Median survival time for patients with any form of dementia was 10.5 years from onset and 5.7 years from diagnosis. Similarly, median survival time for probable Alzheimer disease patients was 11.3 years from onset and 5.7 years from diagnosis. Significant trends of decreasing survival with increasing age group (<70; 70-79, > or = 80) were evident for all dementia patients and for patients with Alzheimer disease. Our findings are consistent with previous studies and provide compelling evidence that survival from onset or diagnosis of dementia depends more on age than any other factor.

Hoyt BD, Massman PJ, Schatschneider C, Cooke N, Doody RS. · Department of Psychology, University of Houston, Houston, Tex, USA. · Arch Neurol. · Pubmed #15767511 links to  free full text

Abstract: BACKGROUND: The apolipoprotein E epsilon4 (APOE epsilon4) allele is associated with an increased risk of developing Alzheimer disease (AD). However, findings regarding an association between the APOE epsilon4 allele and the rate of decline in AD have been mixed. OBJECTIVE: To examine the relationship between the APOE epsilon4 allele and the rate of cognitive and functional decline in AD using individual growth curve analyses. DESIGN: Longitudinal cohort study. SETTING: Alzheimer Disease Research Center at Baylor College of Medicine. PATIENTS: A total of 189 patients meeting NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association) criteria for probable AD at baseline who underwent annual follow-up evaluations for at least 2 years. MAIN OUTCOME MEASURES: Individual growth curve parameters derived from baseline and follow-up performance on global and specific measures of cognitive and functional abilities. RESULTS: Patients with 2 APOE epsilon4 alleles exhibited a slower rate of decline on measures of global cognitive functioning and functional abilities. No significant association was detected between the APOE epsilon4 allele and the rate of decline on measures of specific cognitive functions. CONCLUSIONS: Although the APOE epsilon4 allele is associated with an increased risk of developing AD, it seems that having 2 APOE epsilon4 alleles is associated with a slower clinical course. These findings are consistent with hypotheses that the biological processes contributing to the onset of AD are different from those involved in determining its clinical course.

Atchison TB, Bradshaw M, Massman PJ. · Department of Psychology, University of Houston, USA. · Arch Clin Neuropsychol. · Pubmed #15533693 No free full text.

Abstract: The rate of cognitive decline in AD has been noted to vary significantly among patients. The ability to predict the probable rate of decline early in the disease process would be of great practical importance. Attempts to analyze early cognitive deficits to find patterns associated with rapid decline have met with limited success. This paper utilized a large sample of patients with a diagnosis of probable AD evaluated longitudinally in ongoing research at the ADRC at Baylor College of Medicine and a statistical procedure of profile analysis to assess the initial data for a pattern associated with rapid decline. The findings indicated that despite initial equality of MMSE scores, patients showing rapid MMSE decline at one year displayed significantly more impaired performance on neuropsychological measures at diagnosis. Discussion includes discussion on the use of the MMSE for tracking general cognitive function and the difficulties of ascertaining stable profiles for prediction.

Davis RN, Massman PJ, Doody RS. · Department of Psychology, University of Houston, Houston, TX 77204-5022, USA. · Arch Clin Neuropsychol. · Pubmed #14591475 No free full text.

Abstract: Blood pressure is often lower among patients with Alzheimer's disease (AD) compared to nondemented older adults. Lower blood pressure in AD correlates with reduced cerebral blood flow and cortical atrophy, but its effect on neuropsychological functioning is unclear. We assessed the effects of blood pressure on tests of dementia severity, attention, memory, language, verbal and nonverbal reasoning, motor/psychomotor functioning, and activities of daily living (ADL) among probable AD patients (n=609). As hypothesized, lower systolic blood pressure (SBP) predicted reduced attention (Digits Forward and Backward), memory (Visual Reproduction I), and ADLs. Unexpectedly, lower pulse pressure (SBP-DBP) predicted greater dementia severity (Mini-Mental State Examination, MMSE), attention (Digits Forward and Backward), memory (Logical Memory I and Visual Reproduction I), and ADLs. These findings may reflect a tendency for less severely demented patients to exhibit normal age-related changes in blood pressure, whereas abnormal patterns may develop with increased dementia severity.

Doody RS, Vacca JL, Massman PJ, Liao TY. · Department of Neurology and Alzheimer's disease Research Center, Baylor College of Medicine, Houston, Tex 77030, USA. · Arch Neurol. · Pubmed #10488815 links to  free full text

Abstract: BACKGROUND: Research on the influence of handedness on the clinical presentation and neuropsychology of Alzheimer disease (AD) is scarce. OBJECTIVE: To compare clinical presentation and neuropsychological test performance of right- and left-handed patients with AD. DESIGN: We hypothesized that left-handedness would be associated with younger onset, more rapid progression, and possibly cognitive hemispheric asymmetry. After determining handedness with the Edinburgh Inventory for Handedness for 922 patients with AD, 18 left-handed patients were compared with 18 right-handed patients matched individually on Mini-Mental State Examination scores, education, and age. We compared clinical characteristics (eg, age of onset), estimated rate of initial cognitive decline, language and visuospatial test performances, and patterns of cognitive and motor asymmetries for the 2 groups. SETTING: Alzheimer's Disease Research Center at Baylor College of Medicine, Houston, Tex. MAIN OUTCOME MEASURES: Results of the Wechsler Adult Intelligence Scale-Revised verbal and performance IQ tests, the Western Aphasia Battery sequential commands subtest, the Boston Naming Test, the Halstead-Reitan Finger-Tapping Test, and the calculated Rate of Initial Progression. RESULTS: We found that left-handed patients had younger ages of onset but unexpectedly lower estimated rates of initial cognitive decline, and their results on language tests did not differ from those of right-handed patients. Regarding asymmetry, left-handed patients were more likely than right-handers to obtain lower verbal IQ than performance IQ scores and to exhibit faster finger-tapping speeds with their nondominant hand, but group differences did not attain statistical significance. There were disproportionately few left-handed patients with AD compared with population norms. CONCLUSIONS: Left-handed patients with AD do not differ from right-handed patients in the severity or pattern of neuropsychological deficits. Left-handedness or some factor associated with it may contribute to the early appearance of cognitive deficits during the development of Alzheimer disease, but may temper the subsequent rate of progression of deficits.

Doody RS, Strehlow SL, Massman PJ, Feher EP, Clark C, Roy JR. · Baylor College of Medicine, Department of Neurology and Alzheimer's Disease Research Center, Houston, Texas 77030, USA. · Alzheimer Dis Assoc Disord. · Pubmed #10192643 No free full text.

Abstract: There is no brief patient-derived rating scale for staging and following profoundly demented Alzheimer disease (AD) patients. We developed the Baylor Profound Mental Status Examination (BPMSE) modeled after the Mini-Mental State Examination (MMSE) to meet this need. The BPMSE consists of 25 cognitive questions that assess orientation, language, attention, and motor functioning; 10 examiner ratings of presence or absence of problem behaviors; and 2 qualitative observations of language and social interaction. Two hundred eight probable or possible AD patients (MMSE scores of 20 or less) received the BPMSE. Some were also rated on the clinical dementia rating (CDR) and Lawton activities of daily living (ADL). A ceiling effect occurred at MMSE scores above 11. BPMSE cognitive scores and MMSE scores correlated significantly (r = 0.76, p < 0.0001). Subareas of the BPMSE also intercorrelated significantly. The BPMSE correlated with both CDR and ADL scores (p < 0.001). Internal consistency, interrater reliability, and test-retest stability were excellent. There was no floor effect, and BPMSE scores continued to decline after the MMSE reached 0. The BPMSE is a quick and easy staging tool with excellent validity and test-retest stability that measures cognitive function successfully in patients with MMSE scores below 12. The scale is sensitive to longitudinal change and continues to assess decline when performance has reached the lowest levels on conventional measures.