Distinguishing mild cognitive impairment from healthy aging and Alzheimer’s Disease: The contribution of the INECO Frontal Screening (IFS)

Abstract

Executive functions are affected differently in healthy aging, Mild Cognitive Impairment (MCI) and Alzheimer’s Disease (AD), and evaluating them is important for differential diagnosis. The INECO Frontal Screening (IFS) is a brief neuropsychological screening tool, developed to assess executive dysfunction in neurodegenerative disorders. Goals: We aimed to examine whether and how MCI patients can be differentiated from cognitively healthy controls (HC) and mild to moderate AD patients based on IFS performance. We also explored how IFS scores are associated with age, years of education, and depressive/anxious symptoms (as assessed by the Hospital Anxiety and Depression Scale). Method: IFS total scores were compared between 26 HC, 32 MCI and 21 mild to moderate AD patients. The three groups were matched for age and education. The Area Under the Curve (AUC) was analyzed and optimal cut-offs were determined. Results: Healthy participants had higher IFS scores than both clinical groups, and MCI patients had higher scores than AD patients. IFS showed high diagnostic accuracy for the detection of MCI (AUC = .89, p < .001) and AD (AUC = .99, p < .001), and for the differentiation between the clinical groups (AUC = .76, p < .001). We provide optimal cut-offs for the identification of MCI and AD and for their differentiation. We also found that, in general, higher education predicted higher IFS scores (no associations with age and depressive/anxious symptoms were observed). Altogether, these findings indicate that evaluating executive functions with the IFS can be valuable for the identification of MCI, a high-risk group for dementia, and for differentiating this condition from healthy aging and AD.

Normative data for tests of attention and executive functions in a sample of European Portuguese adult population

“…Education improved performance curvilinearly on M-WCST Categories, Perseverative errors, Total errors, and Stroop Word, and linearly on Stroop Color and Word-Color. This is consistent with prior studies that showed improved executive functions with higher levels of education (Llinas-Regla, Vilalta-Franch, Lopez-Pousa, Calvo-Perxas, & Garre-Olmo, 2013;Moreira et al, 2014;Moreira et al, 2019;Pavão Martins, Maruta, Freitas, & Mares, 2013). Higher education levels appear to contribute to cognitive reserve, behaving as a neuroprotector factor on the decline associated with healthy aging in EF (Roldán-Tapia, Cánovas, León, & García-Garcia, 2017; Thow et al, 2018).…”

“…Executive and attentional dysfunction are common in a wide variety of conditions including acquired brain injury (e.g., TBI: Caeyenberghs et al, 2014;Cicerone & Giacino, 1992;McDonald, Flashman, & Saykin, 2002;Shah et al, 2017;Tramontana, Cowan, Zald, Prokop, & Guillamondegui, 2014), stroke (Olgiati, Russell, Soto, & Malhotra, 2016;Pohjasvaara et al, 2002;Vataja et al, 2003), neuropsychiatric (e.g., bipolar depression: Caixeta et al, 2017;and schizophrenia: Carter et al, 2010;Dirnberger, Fuller, Frith, & Jahanshahi, 2014;Gavilán & García-Albea, 2015), neurodegenerative (e.g., Alzheimer's disease: Amiéva et al, 2004;Binetti et al, 1996;Firbank et al, 2016;Moreira, Lima, Vicente, 2014;Moreira, Costa, Machado, Castro, Lima, & Vicente, 2019;Swanberg, Tractenberg, Mohs, Thal, & Cummings, 2004; the behavioral-variant frontotemporal dementia, bvFTD: Fiorentino et al, 2013;Slachevsky et al, 2004;and Parkinson's: Dirnberger & Jahanshahi, 2013;Lima, Meireles, Fonseca, Castro, & Garret, 2008;Papagno & Trojano, 2018;Zgaljardic et al, 2006), and neurodevelopmental disorders (e.g., ADHD: Kingdon, Cardoso, & McGrath, 2016;Margari et al, 2016;Veloso, Vicente, & Filipe, 2020;and autism: Filipe, Frota, & Vicente, 2019;Miller & Hinshaw, 2015), among many others conditions.…”

Update on Treatments for Cognitive Decline in Alzheimer’s Disease

“…MCI is a stage between the normal CD of aging and dementia; patients with memory and executive function deterioration have a high risk of progressing to dementia. 9 American Association of Neurology (AAN) states the progression to dementia in those older than 65 years with MCI is 14.9%, and the risk of MCI increases with age. 9 Patients with MCI may progress to dementia, remain stable, or return to a neurologically intact status.…”

“…9 American Association of Neurology (AAN) states the progression to dementia in those older than 65 years with MCI is 14.9%, and the risk of MCI increases with age. 9 Patients with MCI may progress to dementia, remain stable, or return to a neurologically intact status. 9 There are no evidence-based studies indicating that pharmacologic therapies for MCI are effective.…”

“…9 Patients with MCI may progress to dementia, remain stable, or return to a neurologically intact status. 9 There are no evidence-based studies indicating that pharmacologic therapies for MCI are effective. 9,10 Definitions of MCI and AD can be confusing, a new definition for AD proposes that the diagnosis be confined to the presence of biomarkers for amyloid and tau, 11 but if only amyloid pathology is present, the label would be changed to "AD Pathologic Change"; both diagnoses are independent of the clinical status of the patient.…”