Utility of a computerized program (EXPERIADEM) for the evaluation and register of patients with cognitive decline and dementia
J.M. Manubens, P. Martínez-Lage, M. Barandiarán, I. Francés, D. Villar, Y. Monzón, M.A. Ramos, P. Quesada, S. Moreno
Pamplona, Navarra (Spain)
Introduction. EXPERIADEM is a computer program that includes different study protocols for the evaluation of patients with dementia or cognitive decline and allows to set up a complete registry of cases.
It has been specifically designed to facilitate the evaluation of patients with the actual use of the computer during the clinical interview. Hard copies of all tests as well as complete clinical report and statistical analysis of data can be performed.
Objective. To ascertain the utility and applicability of EXPERIADEM for the clinical and neuropsychological examination of subjects with cognitive impairment and dementia.
Methods. Direct comparison of two samples:
AD GROUP included 80 no consecutive patients with a diagnosis of probable Alzheimer's disease attending a memory clinic;
ND GROUP included 50 non-demented subjects selected from a population based longitudinal study of mild cognitive impairment (MCI). Subjects with a Mini-Mental score of 24 or less in the absence of dementia were considered for MCI. Also, subjects whose MMSE scores at the second evaluation at one year fell by one or more points were considered as cognitive decliners (CD).
The computerized study protocol included a clinical interview, neurological examination, family history, basic and instrumental daily activities assessment scales, as well as a combination of neuropsychological tests from the CERAD (Consortium to Establish a Registry of patients with Alzheimer's Disease) and GERMCIDE (Study Group on Demetia and Behavioural Neurology, Spanish Neurological Society) protocol. Laboratory and other ancillary investigations data including APO-E genotype were entered into the data-base.
Results. Mean age and male/female proportion of subjects in the AD GROUP was (78,7 ± 7,6; 21 men/59 women).
Among the 50 subjects on the ND GROUP (23 men/27 women; mean age: 72 ± 0,8) 12 had MCI and 15 had CD. Eighteen subjects showed no decline (equal or higher performance in the MMSE at the second evaluation) and were considered as controls.
Cognitive scores in all tests performed were lower in the AD GROUP as compared to controls. Tests of verbal fluency and verbal/visual memory (learning a word list, delayed recall and delayed recall of the CERAD constructional praxis drawings) helped to differenciate patients with MCI or CD from controls.
Mean time for the administration of the study protocol was 60'. The protocol was well tollerated by all patients and subjects.
Conclusions. EXPERIADEM is a useful, easily administered, and well tollerated tool for the evaluation of patients with memory complaints to investigate the existence of cognitive impairment or dementia.
The actual use of the computer during the interview requires little training and allows to set up a complete data-base and registry of all gathered data in a single, reasonably time, visit. Follow up visits can be easily registered.
Administration of the basic protocol including neurological and neuropsychological examination is 60 to 90 minutes. The extent (and duration) of the cognitive evaluation can be increased or decreased by the examiner for every individual patient. (Reunión europea "Pathways from Science to Effecting Patient Management in Dementia". Istanbul, Turkey, 23-25 March 2001 (Póster ganador)).
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