Accuracy of praxis test from Cambridge Cognitive Examination (CAMCOG) for Alzheimer’s disease: a cross-sectional study

Abstract

BACKGROUND: Praxis impairment may be one of the first symptoms manifested in dementia, primarily in cortical dementia. The Cambridge Cognitive Examination (CAMCOG) evaluates praxis, but little is known about the accuracy of CAMCOG for diagnosing dementia. The aims here were to investigate the accuracy of praxis and its subitems in CAMCOG (constructive, ideomotor and ideational subitems) for diagnosing Alzheimer's disease (AD) among elderly patients. DESIGN AND SETTING: Cross-sectional study on community-dwelling elderly people. METHODS: 158 elderly patients were evaluated. CAMCOG, Mini-Mental State Examination and Pfeffer Functional Activities Questionnaire were used. ROC curve analysis was used to establish cutoff points. RESULTS: The total scores for praxis and the constructive subitem presented significant differences (P < 0.0001) between healthy elderly people and AD patients. Stage of dementia (clinical dementia rating, CDR = 0, 1 and 2) showed that total and constructive praxis can be used to classify the stages of dementia (mild and moderate cases), i.e. constructive praxis classified 88% of the patients with mild dementia (P < 0.0001) while total praxis classified 56% with moderate dementia. Comparison of normal controls (NC) and mild dementia cases showed specificity of 71% and sensitivity of 88% (AUC = 0.88; P < 0.0001). CONCLUSION: Some praxis subtests can have higher predictive diagnostic value for detecting Alzheimer's disease in mild stages (total praxis AUC = 0.858; P < 0.0001; constructive AUC = 0.972; P < 0.0001). Constructive praxis as measured using CAMCOG may contribute towards diagnosing dementia, because occurrence of impairment of praxis may help in recognizing an evolving dementia syndrome.

Loss of functional capacity in elderly individuals with Alzheimer disease

“…Two variables, staging and cognitive performance, influenced the progress of the condition in this sample. [30][31][32][33][34][35][36] As AD is a neurodegenerative condition, the significant relationship between MMSE and FAQ in this study (p<0.001) also agrees with studies reported in the literature, considering that the evolution of this condition is marked by the progression of cognitive deficit in these aged individuals. Sobral et al 36 reported a significant relationship between the MMSE score and CDR, which corroborates our results, confirming cognitive worsening with disease progression.…”

Effects of Selenium Supplementation in Patients with Mild Cognitive Impairment or Alzheimer’s Disease: A Systematic Review and Meta-Analysis

“…Cardoso et al [ 31 ] demonstrated that individuals with AD who received a supranutritional amount of Se demonstrated a subtle but significant improvement in MMSE, which was associated with an increase in CSF Se levels. Moreover, Cardoso et al [ 30 ] observed that individuals with MCI daily supplemented with Se through Brazil nut intake demonstrated positive responses to certain cognitive functions, such as verbal fluency (storage capacity of the semantic memory system, the ability to retrieve information stored in memory, and the processing of executive functions [ 52 ]), and constructive praxis (to assess an individual’s motor, visuospatial, and visuoconstructive skills [ 53 ]). When Se supplementation was associated with other nutrients, patients with AD also demonstrated a small improvement in memory performance [ 35 , 36 ].…”

Reavaliação da incidência de demência e a evolução clínica, cognitiva e estrutural encefálica durante 12 anos em idosos de Ribeirão Preto - SP

“…Um tópico importante a ser destacado corresponde à função executivapraxia. A função praxia pode ser utilizada como forma de rastreamento confiável para demência subcortical e o comprometimento desta função fornece dados prognósticos mais precisos para o declínio cognitivo e para a incapacidade funcional (CECATO et al, 2018).…”

“…Os escores totais da praxia e da forma construtiva tiveram diferenças significativas (p<0,0001) entre idosos saudáveis e pacientes com DA; além disso tanto a praxia total quanto a forma construtiva podem classificar os estágios de demência (casos leves e moderados) (CECATO et al, 2018 Síndrome demencial é um fator determinante forte para institucionalização, independente da presença de outras doenças crônicas, perfil sociodemográfico e incapacidade funcional, com taxa de até 61% da população observada por 3 anos (AGÜERO-TORRES et al, 2001). A institucionalização também pode ser consequência da carga de estresse do cuidador que tem fatores positivamente modificáveis associados, como a maior carga para o cuidador e não modificáveis, como idade avançada, estado profissionalmente ativo e maior nível de escolaridade do cuidador (VANDEPITTE et al, 2018).…”

“…Na forma ideacional da práxis, os pacientes precisam ser capazes de colocar um papel dentro de um envelope (1 ponto). A pontuação total possível para os itens da praxia é de 12 pontos e escore baixo indica comprometimento (apraxia)(CECATO et al, 2018).Os pontos de corte definidos para IQCODE e B-ADL foram respectivamente: >3,40 e >3,19(BUSTAMANTE et al, 2003). Quanto aos pontos de corte adotados para o MEEM, consideraram-se os diferentes níveis de escolaridade: corte a depender da escolaridade: ≥ 8 anos: normal se ≥ 13 animais; < 8 anos: ≥ 8 animais(NITRINI et al, 1994).…”