Hostname: page-component-59f8fd8595-hk2jd Total loading time: 0 Render date: 2023-03-22T14:05:52.856Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true
  • English

Longitudinal Cognitive, Electroencephalographic and Morphological Brain Changes in Ageing and Alzheimer's Disease

Published online by Cambridge University Press:  02 January 2018

Hans Förstl ,
Herbert Sattel ,
Christoph Besthorn ,
Sabine Daniel ,
Claudia Geiger-Kabisch ,
Frank Hentschel ,
Manfred Sarochan  and
Rainer Zerfaß
Hans Förstl*
Affiliation:
University of Western Australia
Herbert Sattel
Affiliation:
Central Institute of Mental Health J5, 68159, Mannheim, Germany
Christoph Besthorn
Affiliation:
Central Institute of Mental Health J5, 68159, Mannheim, Germany
Sabine Daniel
Affiliation:
Central Institute of Mental Health J5, 68159, Mannheim, Germany
Claudia Geiger-Kabisch
Affiliation:
Central Institute of Mental Health J5, 68159, Mannheim, Germany
Frank Hentschel
Affiliation:
Central Institute of Mental Health J5, 68159, Mannheim, Germany
Manfred Sarochan
Affiliation:
Central Institute of Mental Health J5, 68159, Mannheim, Germany
Rainer Zerfaß
Affiliation:
Central Institute of Mental Health J5, 68159, Mannheim, Germany
*
Prof. Hans Förstl, Department of Psychiatry and Behavioural Science, University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands, Perth, Western Australia 6009. Fax 0061-9-3463828
Get access Rights & Permissions[Opens in a new window]

Abstract

Background

The natural course of cognitive performance, electrophysiological alterations and brain atrophy in ageing and Alzheimer's disease (AD) has been investigated in numerous studies, but only few attempts have been made to examine the relationship between clinical, electroencephalographic (EEG) and morphological changes with quantitative methods prospectively over longer periods of time.

Method

Fifty-five patients with clinically diagnosed AD and 66 healthy elderly controls were examined biannually using a cognitive test (CAMCOG), EEG band power and volumetric estimates of brain atrophy.

Results

On average cognitive performance deteriorated by 28 points on the CAMCOG in the AD group, the alpha/theta ratio decreased by 0.2, and the proportion of intracranial cerebrospinal fluid volume increased by 3.5% during a 2-year period. Similar changes were observed after a second 2-year interval. A multiple regression model demonstrated a significant influence of age on cognition and atrophy and a significant influence of the estimated duration of symptoms on cognition, alpha/theta ratio and brain atrophy at the initial examination. Cognitive performance at the first examination exerted significant effects on the performance and also on brain atrophy at re-examination after 2 or 4 years, whereas the EEG and neuroimaging findings at the previous examination were exclusively related to the corresponding findings at the follow-up examinations. In the control group no significant cognitive, EEG and morphological changes were observed after 2 and 4 years.

Conclusion

After 2 consecutive follow-up periods, we were able to verify significant deteriorations of cognition accompanied by neurophysiological and neuroradiological changes in AD, but not in normal ageing. In clinically diagnosed AD, cognitive performance at the follow-up examination could not be predicted by the previous alpha/theta ratio or by the previous degree of global brain atrophy, whereas the cognitive test score determined not only performance, but also structural findings at follow-up. Performance on cognitive tests appears to be a more sensitive indicator of the degenerative process than EEG band-power and morphological changes in manifest AD. Neuroimaging, neurophysiology and genetic risk markers may be more important for the early differential diagnosis than for the prediction of the course of illness.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 168 , Issue 3 , March 1996 , pp. 280 - 286
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Berg, L., Miller, J. P., Storandt, M., et al (1988) Mild senile dementia of the Alzheimer type: 2. longitudinal assessment. Annals of Neurology, 23, 477–484.CrossRefGoogle ScholarPubMed
Besthorn, C., Förstl, H., Geiger-Kabisch, C., et al (1994) EEG-coherence in Alzheimer disease. Electroencephalography and Clinical Neurophysiology, 90, 242–245.CrossRefGoogle ScholarPubMed
Bollen, K. S. (1989) Structural Equations with Latent Variables. New York: John Wiley & Sons.CrossRefGoogle Scholar
Burns, A., Jacoby, R. & Levy, R. (1991a) Progression of cognitive impairment in Alzheimer's disease. Journal of the American Geriatric Society, 39, 39–45.CrossRefGoogle ScholarPubMed
Burns, A., Jacoby, R. & Levy, R. (1991b) Computed tomography in Alzheimer's disease: a longitudinal study. Biographical Psychiatry, 29, 383–390.Google ScholarPubMed
Coben, L. A., Danziger, W. & Storandt, M. (1985) A longitudinal EEG study of mild senile dementia of Alzheimer type: changes at 1 year and at 2.5 years. Electroencephalography and Clinical Neurophysiology, 61, 101–112.CrossRefGoogle ScholarPubMed
DeCarli, C., Haxby, J. V., Gillette, J. A., et al (1992) Longitudinal changes in lateral ventricular volume in patients with dementia of the Alzheimer type. Neurology, 42, 2029–2036.Google ScholarPubMed
Förstl, H., Besthorn, C., Geiger-Kabisch, C., et al (1993) Psychotic features and the course of Alzheimer's disease: relationship to cognitive, electroencephalographic and computerized tomography findings. Acta Psychiatrica Scandinavica, 87, 395–399.CrossRefGoogle ScholarPubMed
Förstl, H., Hentschel, F., Sattel, H., et al (1995) Age-associated memory impairment and early Alzheimer's disease. Only time will tell the difference. Arzneimittel-Forschung/Drug Research, 45, 395–397.Google ScholarPubMed
Förstl, H., Zerfass, R., Geiger-Kabisch, C., et al (1995b) Brain atrophy in normal ageing and Alzheimer's disease: volumetric discrimination and clinical correlations. British Journal of Psychiatry, 167, 739–746.CrossRefGoogle ScholarPubMed
Haupt, M., Kurz, A. & Pollmann, S. (1992) Severity of symptoms and rate of progression in Alzheimer's disease: a comparison of cases with early and late onset. Dementia, 3, 21–24.Google Scholar
Hooijer, C., Jonker, C., Posthuma, J., et al (1990) Reliability, validity and follow-up of the EEG in senile dementia: sequelae of sequential measurement. Electroencephalography and Clinical Neurophysiology, 76, 400–412.CrossRefGoogle ScholarPubMed
Jobst, K. A., Smith, A. D., Barker, C. S., et al (1992) Association of atrophy of the medial temporal lobe with reduced blood flow in the posterior parietotemporal cortex in patients with a clinical and pathological diagnosis of Alzheimer's disease. Journal of Neurology, Neurosurgery and Psychiatry, 55, 190–194.CrossRefGoogle ScholarPubMed
Jobst, K. A., Smith, A. D., Szatmari, M., et al (1994) Rapidly progressing atrophy of medial temporal lobe in Alzheimer's disease. Lancet, 343, 829–830.CrossRefGoogle ScholarPubMed
Little, A. & Burns, A. (1993) Monitoring change in Alzheimer's disease. In Ageing and Dementia (ed. Burns, A.). London: E. Arnold.Google Scholar
Leuchter, A., Simon, S. L., Daly, K. A. et al (1994) Quantitative EEG-correlates of outcome in older psychiatric patients. Part I: cross-sectional and longitudinal assessment of patients with dementia. American Journal of Geriatric Psychiatry, 2, 200–209.CrossRefGoogle ScholarPubMed
Lopez, O. L., Becker, J. T., Brenner, R. P., et al (1991) Alzheimer's disease with delusions and hallucinations: neuropsychological and electroencephalographic correlates. Neurology, 41, 906–912.CrossRefGoogle ScholarPubMed
Lucca, U., Comelli, M., Tettamanti, M., et al (1993) Rate of progression and prognostic factors in Alzheimer's disease: a prospective study. Journal of the American Geriatric Society, 41, 45–49.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., et al (1984) Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Morris, J. C., Edland, S., Clark, C., et 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, 2457–2465.CrossRefGoogle Scholar
Mortimer, J. A., Ebbitt, B., Jun, S.-P., et al (1992) Predictors of cognitive and functional progression in patients with probable Alzheimer's disease. Neurology, 42, 1689–1696.CrossRefGoogle ScholarPubMed
Roth, M., Tym, E., Mountjoy, C., et al (1986) CAMDEX: a standardized instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. British Journal of Psychiatry, 149, 698–709.CrossRefGoogle Scholar
Schreiter-Gasser, U., Gasser, T. & Ziegler, P. (1993) Quantitative EEG analysis in early onset Alzheimer's disease: a controlled study. Electroencephalography and Clinical Neurophysiology, 86, 15–22.CrossRefGoogle ScholarPubMed
Sloan, E. P. & Fenton, G. W. (1993) EEG power spectra and cognitive change in geriatric psychiatry: a longitudinal study. Electroencephalography and Clinical Neurophysiology, 86, 361–367.CrossRefGoogle ScholarPubMed
Smith, G. S., de Leon, M. J., George, A. E., et al (1992) Topography of cross-sectional and longitudinal glucose metabolic deficits of Alzheimer's disease. Physiologic implications. Archives of Neurology, 49, 1142–1150.CrossRefGoogle Scholar
Soininen, H., Partanen, J., Laulumaa, V., et al (1989) Longitudinal EEG spectral analysis in early stage of Alzheimer's disease. Electroencephalography and Clinical Neurophysiology, 72, 290–297.CrossRefGoogle ScholarPubMed
Stern, R. G., Mohs, R. C., Bierer, L. M., et al (1992) Deterioration on the blessed test in Alzheimer's disease: longitudinal data and their implications for clinical trials and identification of subtypes. Psychiatry Research, 42, 101–110.CrossRefGoogle ScholarPubMed
Stern, Y., Albert, M., Brandt, J., et al (1994) Utility of extrapyramidal signs and psychosis as predictors of cognitive and functional decline, nursing home admission, and death in Alzheimer's disease: prospective analyses from the predictors study. Neurology, 44, 2300–2307.CrossRefGoogle ScholarPubMed
Thal, L. J., Grundman, M. & Klauber, M. (1988) Dementia: characteristics of a referral population and factors associated with progression. Neurology, 38, 1083–1090.Google ScholarPubMed
Wippold, F. J., Gado, M. H., Morris, J. C., et al (1991) Senile dementia and healthy aging: a longitudinal CT study. Radiology, 179, 215–219.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.