Year: 2019
Type: article
Abstract: Diagnosing Alzheimer's disease (AD) and related disorders requires evidence of cognitive decline followed, increasingly, by detection of a biomarker. Cognition is assessed heterogeneously across clinics/centers, undermining consistency of diagnosis, assessment reliability, use of biomarkers and their informative value, and increasing costs (follow-ups in different centers and second opinions re-expose to local batteries). Heterogeneous cognitive assessment disadvantages research by reducing ability to pool data across an increasing number of multicenter studies. Thus, some degree of standard cognitive assessment is urgently needed. A global effort for harmonization was launched with a 2018 dedicated workshop in Geneva, Switzerland and a presentation at the 2018 ISTAART Cognition PIA Scientific Session. Experts from pertinent initiatives (e.g., EADC, NACC, ADNI, DOMS, etc.), clinicians from primary and tertiary memory clinics, and other stakeholders prioritized issues for an effective harmonization roadmap. Decisions were made consensually through plenary or subgroup in-person or online consultations, and through content-specific working groups. Workgroups defined requirements to produce normative data consistently across tests, languages and cultures. These included: a) a consensual definition of normal populations (excluding hyper-normals); b) three levels of education classification (i.e., primary/lower-secondary, upper-secondary, post-secondary) consistent with the International Standard Classification of Education; c) minimum sample sizes compatible with use of parametric statistics (i.e., 8 subjects by 6 age decades, by 3 education levels, by 2 genders). Workgroup participants agreed to the adoption of U.S. NACC UDS-3 cognitive tests, a path requiring minimal effort for a first global alignment. The main adjustment consists of adopting the local analogs to allow use of existing normative data. To date, we have merged results, know-how and resources of main harmonization consortia and defined priorities, basic methodology and starting points for a promising roadmap to standard cognitive assessment. Next developments will address consistency in testing across different contexts (e.g., case-finding and screening, outcome assessment for clinical trials, theragnostics, etc.) to allow modularity of assessment and minimize need for repeated testing. International validation of the standard cognitive test battery, generation of reliable normative data, and implementation in clinics and research will require consensual and concerted effort by research and clinical centers worldwide.
Source: Alzheimer s & Dementia
Authors: Marina Boccardi, Andreas U. Monsch, Stefano Cappa, Bruno Dubois, David P. Salmon, Henry Brodaty, Jean Georges, Bengt Winblad, Giovanni B. Frisoni, Matthias Kliegel, Task Force for Harmonizing Neuropsychological Assessment for Dementing Neurodegenerative Disorders
Institutions: University of Geneva, Felix Platter-Hospital, Istituto Universitario di Studi Superiori di Pavia, Centro San Giovanni di Dio Fatebenefratelli, Assistance Publique – Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Institut du Cerveau, University of California San Diego, UNSW Sydney, Alzheimer Europe, Karolinska Institutet
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2980955733