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Progression of Alzheimer's disease during a three-year follow-up using the CERAD-NB total score: Kuopio ALSOVA study

  • Ilona Hallikainen (a1), Tuomo Hänninen (a2), Mikael Fraunberg (a3), Kristiina Hongisto (a1), Tarja Välimäki (a4) (a5), Asta Hiltunen (a6), Pertti Karppi (a7), Juhani Sivenius (a1) (a8), Hilkka Soininen (a1) (a2) and Anne M. Koivisto (a1) (a2)...


Background: We studied the suitability of The Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Battery (CERAD-NB) total score for monitoring Alzheimer's disease (AD) progression in early-diagnosed medicated patients. We also investigated possible differences in progression between patients with very mild or mild baseline AD.

Methods: In this three-year follow-up of 115 ALSOVA study patients with clinical dementia ratings (CDR) of very mild (0.5) or mild (1) AD, we analyzed total CERAD-NB, Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), The Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory, and Clinical Dementia Rating Sum of Boxes scores. Correlations were identified with efficacy parameters.

Results: Over three years, total CERAD-NB declined significantly in both groups. Annual change rates of total CERAD-NB were also significant. Total CERAD-NB revealed annual differences in cognition between study groups, while MMSE did not. Total CERAD-NB correlated well with other cognitive and global measures, but not with NPI. For almost two years, the CDR-0.5 group maintained a higher activities of daily living than the CDR-1 group exhibited at baseline. Furthermore, the CDR-0.5 group showed milder neuropsychiatric symptoms at the end of follow-up than the CDR-1 group showed at baseline.

Conclusions: The CERAD total score is a suitable and sensitive follow-up tool in longitudinal AD trials. Cognition progression rates did not significantly differ between study groups; however, patients with very mild AD at baseline had milder neuropsychiatric symptoms after long-term follow-up. This emphasizes the importance of early diagnosis and assessment of neuropsychiatric symptoms at the diagnostic visit and during follow-up.


Corresponding author

Correspondence should be addressed to: Anne Maria Koivisto, MD, PhD, Neurology of Neuro Center, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland. Phone: +358-40-738 9049, +358-44-717 5629; Fax: +358-17-172305. Email:


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APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn.Washington, DC: American Psychiatric Association.
Birks, J. (2006). Cholinesterase inhibitors for Alzheimer's disease. Cochrane Database of Systematic Reviews, CD005593. Review. PubMed PMID: 16437532
Bozoki, A. C., An, H., Bozoki, E. S. and Little, R. J. (2009). The existence of cognitive plateaus in Alzheimer's disease. Alzheimer's and Dementia, 5, 470478.
Chandler, M. al. (2005). A total score for the CERAD neuropsychological battery. Neurology, 65, 102106.
Cortes, al. (2005). Recent data on the natural history of Alzheimer's disease: results from the REAL.FR study. Journal of Nutrition, Health and Aging, 9, 8693.
Cortes, al. (2008). Prognosis of Alzheimer's disease today: a two-year prospective study in 686 patients from the REAL-FR study. Alzheimer's and Dementia, 4, 2229.
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314.
Cummings, J. L., Schneider, E., Tariot, P. N. and Graham, S. M. (2006). Behavioral effects of memantine in Alzheimer disease patients receiving donepezil treatment. Neurology, 67, 5763.
Feldman, H. H., Van Baelen, B., Kavanagh, S. M. and Torfs, K. E. (2005). Cognition, function, and caregiving time patterns in patients with mild-to-moderate Alzheimer disease: a 12-month analysis. Alzheimer Disease and Associated Disorders, 19, 2936.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Galasko, al. (1997). An inventory to assess activities of daily living for clinical trials in Alzheimer's disease. The Alzheimer's disease cooperative study. Alzheimer Disease and Associated Disorders, 11 (Suppl. 2), S3339.
Hallikainen, al. (2012). Cognitive and neuropsychiatric symptom differences in early stages of Alzheimer's disease: Kuopio ALSOVA study. Dementia and Geriatric Cognitive Disorders Extra, 2, 209218. doi:10.1159/000338231.
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. The British Journal of Psychiatry, 140, 566572.
Karttunen, al. (2011). Neuropsychiatric symptoms and quality of life in patients with very mild and mild Alzheimer's disease. International Journal of Geriatric Psychiatry, 26, 473482. doi:10.1002/gps.2550. Epub 2010 Oct 29.
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939944.
McLaughlin, al. (2010). Assessment of potential measures in models of progression in Alzheimer disease. Neurology, 75, 12561262.
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 24122414.
Morris, J. al. (1989). The consortium to establish a registry for Alzheimer's disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology, 39, 11591165.
Morris, J. al. (1993). The consortium to establish a registry for Alzheimer's disease (CERAD). Part IV. Rates of cognitive change in the longitudinal assessment of probable Alzheimer's disease. Neurology, 43, 24572465.
Pulliainen, V., Hokkanen, L., Salo, J. and Hänninen, T. (1999). CERAD-kognitiivinen tehtäväsarja. Käsikirja. [Manual of the Finnish version of the CERAD neuropsychological battery]. Kuopio: Suomen Alzheimertutkimusseura ry.
Rossetti, H. C., Munro Cullum, C., Hynan, L. S. and Lacritz, L. H. (2010). The CERAD Neuropsychologic Battery Total Score and the progression of Alzheimer disease. Alzheimer Disease and Associated Disorders, 24, 138142.
Salloway, al. (2009). A phase 2 multiple ascending dose trial of bapineuzumab in mild to moderate Alzheimer disease. Neurology, 73, 20612070.
Seo, E. al. (2010). Total scores of the CERAD neuropsychological assessment battery: validation for mild cognitive impairment and dementia patients with diverse etiologies. The American Journal of Geriatric Psychiatry, 18, 801809.
Serra, al. (2010). Relationship between cognitive impairment and behavioural disturbances in Alzheimer's disease patients. Behavioural Neurology, 23, 123130.
Stein, al. (2012). The assessment of changes in cognitive functioning: age-, education-, and gender-specific reliable change indices for older adults tested on the CERAD-NP battery: results of the German study on ageing, cognition, and dementia in primary care patients (AgeCoDe). The American Journal of Geriatric Psychiatry, 20, 8497.
Steinberg, al. (2008). Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. International Journal of Geriatric Psychiatry, 23, 170177.
Stern, R. al. (1994). A longitudinal study of Alzheimer's disease: measurement, rate, and predictors of cognitive deterioration. The American Journal of Psychiatry, 151, 390396.
Tractenberg, R. E., Weiner, M. F., Cummings, J. L., Patterson, M. B. and Thal, L. J. (2005). Independence of changes in behavior from cognition and function in community-dwelling persons with Alzheimer's disease: a factor analytic approach. The Journal of Neuropsychiatry and Clinical Neurosciences, 17, 5160.
Välimäki, T. H., Vehviläinen-Julkunen, K. M., Pietilä, A. M. and Pirttilä, T. A. (2009). Caregiver depression is associated with a low sense of coherence and health-related quality of life. Aging and Mental Health, 13, 799807.
Welsh, K. al. (1994). The consortium to establish a registry for Alzheimer's disease (CERAD). Part V. A normative study of the neuropsychological battery. Neurology, 44, 609614.


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Progression of Alzheimer's disease during a three-year follow-up using the CERAD-NB total score: Kuopio ALSOVA study

  • Ilona Hallikainen (a1), Tuomo Hänninen (a2), Mikael Fraunberg (a3), Kristiina Hongisto (a1), Tarja Välimäki (a4) (a5), Asta Hiltunen (a6), Pertti Karppi (a7), Juhani Sivenius (a1) (a8), Hilkka Soininen (a1) (a2) and Anne M. Koivisto (a1) (a2)...


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