How Is Your Memory?Evaluating Memory in the
Individual and Its Relationship to Alzheimer's
Disease
How Is Your Memory?Evaluating Memory in the
Individual and Its Relationship to Alzheimer's
DiseaseJ. Wesson Ashford, M.D., Ph.D.
Clinical Professor (affiliated)
Psychiatry & Behavioral Sciences, Stanford University
Senior Research Scientist
Stanford/VA Aging Clinical Research Center,
VA Palo Alto Health Care System
Palo Alto, California
Dementia DefinitionDementia Definition
Multiple Cognitive Deficits: Memory dysfunction especially new learning, a prominent early
symptom At least one additional cognitive deficit
• aphasia, apraxia, agnosia, or executive dysfunction
Cognitive Disturbances: Sufficiently severe to cause impairment of
occupational or social functioning and Must represent a decline from a previous level of
functioning
Alzheimer’s DiseaseAlzheimer’s Disease
First described by Alois Alzheimer, a German neuropathologist, in 1907
Observed in a 51-year-old female patient with paranoia, memory loss, disorientation, and hallucinations
Postmortem studies characterized senile plaques and neurofibrillary tangles (NFTs) in the cerebral cortex Senile plaques: Extracellular
accumulation of insoluble fragments of beta-amyloid (A1-42)
NFTs: Intracellular accumulation of hyperphosphorylated tau strands
Need for Mass ScreeningNeed for Mass ScreeningAlzheimer’s disease, dementia, and memory
problems are difficult to detect when they are mild about 90% missed early about 25% are still missed late
There are important accommodations and interventions that should be made when there are cognitive impairments (like needing glasses or having driving
restrictions if you have vision problems)
Audience ScreeningAudience Screening
Presentation of complex pictures (that are easily remembered normally) are useful for detecting memory difficulties
Testing memory using a pictures approach needs standardization for population use
Picture memory is less affected by education
Picture memory can be tested by computer
Audiences can be shown slide presentations
BEGINNING INSTRUCTIONSBEGINNING INSTRUCTIONS1) Open the booklet
2) Read the Screening for Memory Problems Information Sheet
3) Fill out the Demographic Information sheet
4) Turn over the Demographic Information sheet and read the instructions under for the Answer Sheet for Memory Screening
Screening for Memory ProblemsInformation Sheet
IRB FORM (exempt)
Screening for Memory ProblemsInformation Sheet
IRB FORM (exempt) Description: You are invited to participate in a research study of memory and aging. You
will take a memory test that involves looking at a number of pictures and indicating which are duplicated. You may also be asked to remember a list of words, or to take other brief memory tests. If the results of these tests indicate that you may have some memory concerns, we may offer you the opportunity to participate in more detailed memory studies.
For Questions About This Study: If you have any questions about this study, please contact: Dr. Wes Ashford, Aging Clinical Research Center, 3801 Miranda Avenue (151Y), VA Palo Alto Health Care System, Palo Alto, CA 94304, (650) 852-3287.
Purpose: This is a research program to screen for memory problems. Information we collect about you will be added to information about other people and analyzed to help researchers and clinicians better understand how memory changes with aging. The results of this research study may be presented at scientific or medical meetings or published in scientific journals. However, personal information or your identity will not be disclosed. Your participation in this research study will take approximately 30 minutes to one hour.
Participation is Voluntary: If you have read this form and have decided to participate in this project, please understand your participation is voluntary and you have the right to withdraw your consent or discontinue participation at any time without penalty or loss of benefits to which you are otherwise entitled. You have the right to refuse to answer particular questions. Your individual privacy will be maintained in all published and written data resulting from the study.
Independent Contact: If you are not satisfied with the manner in which this study is being conducted, or if you have any concerns, complaints, or general questions about the research or your rights as a research study subject, please contact the Stanford Institutional Review Board (IRB) to speak to an informed individual who is independent of the research team at (650)-723-5244 or toll free at 1-866-680-2906. Or write the Stanford IRB, Administrative Panels Office, Stanford University, Stanford, CA 94305-5401.
Demographic Information (front of sheet)
(circle, check, or fill in answers)
Demographic Information (front of sheet)
(circle, check, or fill in answers)
Month of Birth: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Year of Birth: 19 _____ ____
Gender: Male __________ Female__________
Education Level (number of years): ________
1 Elementary (0-6) 2 Jr. High School (7-8) 3 High School (12)
4 Some College (13-15) 5 AA Degree (14) 6 Bachelors Degree (16)
7 Masters Degree (18) 8 PhD, MD, JD (20+) 9 Other or unknown
Veteran Status: Vet_____ NonVet______ Unknown_____
Occupation: _______
1 Never employed 2 Student 3 Homemaker
4 Unskilled/semiskilled 5 Skilled trade/craft 6 Clerical/office Worker
7 Manager Business/Gov 8 Professional/Technical 9 Other or Unknown
Employment Status: Full Time____ Part Time____ Unemployed____ Retired____
Primary Race: __________
1 White 2 Black or African American
3 American Indian or Native Alaskan 4 Native Hawaiian or other Pacific Islander
5 North Asian (i.e., China, Japan) 6 Middle East/South Asian
7 More than one race 8 Decline to state
9 Unknown
Hispanic Ethnic Background? No____ Yes____ Unknown____
Have you had problems with your memory recently?
Yes_______ No__________
Answer Sheet for Memory Screening (back of sheet)Carefully look at each picture. If you see a picture that you have seen before, mark the circle next to the number of the repeat picture. For the main test, you will see 50 pictures. Each picture is numbered. The pictures will stay on the screen for 5 seconds. 25 pictures are new, 25 pictures are repeated.
MemTraxMemTraxMemory GAMEMemory GAMEMemTraxMemTrax
Memory GAMEMemory GAME 50 pictures will be shown (there are 10
practice pictures that will be shown first).
When you see a picture for the first time, look at it carefully and try to remember it.
If you recognize a picture that you have seen before, then look at the number and fill in the circle next to that number.
1 O =>> 1
1
1
22
3
4
5
6
7
8
9
10
Practice Test:(circles should be marked for
repeats)
Practice Test:(circles should be marked for
repeats)
1 O (New)
2 O (New)
3 O (New)
4 (Repeat)
5 O (New)
6 (Repeat)
7 O (New)
8 (Repeat)
9 (Repeat)
10 (Repeat)
11
22
33
44
55
66
77
88
99
1010
1111
1212
1313
1414
1515
1616
1717
1818
1919
2020
2121
2222
2323
2424
2525
2626
2727
2828
2929
3030
3131
3232
3333
3434
3535
3636
3737
3838
3939
4040
4141
4242
4343
4444
4545
4646
4747
4848
4949
5050
THE ENDTHE END
Please note the number on your answer sheet, then hand it in.
MEMTRAX Memory Test
116 subjects – mostly elderly normals, some young, some dementia patientsFalse positive errors (false recognition) – 33(64);6(58);47(27)—4,18,23,34(1);1,2,8(0)False negative errors (failure to recognize) – 35(33);27(20);5(16)—32(4);24(3);45(3)
Test Performancefor 1018 subjectsTest Performance
for 1018 subjects
82 (8%) had perfect scores,82 (8%) had perfect scores,
230 (23%) made 1 error (98% correct), 230 (23%) made 1 error (98% correct),
700 (69%) made 5 or fewer errors (700 (69%) made 5 or fewer errors (>>90% correct),90% correct),
132 (13%) made 6 – 10 errors (80 – 88% correct),132 (13%) made 6 – 10 errors (80 – 88% correct),
186 (18%) made > 10 errors (<80% correct).186 (18%) made > 10 errors (<80% correct).
----------------------------------------------------------------------------------------------------------------------------------------
70 (7%) scored < 80% correct for True Negatives70 (7%) scored < 80% correct for True Negatives 19 (6%) males, 51 (8%) females 19 (6%) males, 51 (8%) females
• (false positive responses = saying a picture is repeated when not),(false positive responses = saying a picture is repeated when not),
79 (8%) scored < 80% correct for True Positives79 (8%) scored < 80% correct for True Positives 25 (7%) males, 54 (8%) females 25 (7%) males, 54 (8%) females
• (false negative responses = failure to recognize/recall repeat (false negative responses = failure to recognize/recall repeat picture).picture).
True Negative Performance
y = -0.0352x + 25.564
R2 = 0.039
y = -0.0597x + 27.24
R2 = 0.141
1213141516171819202122232425
40.0 50.0 60.0 70.0 80.0 90.0 100.0
Age (years)
Nu
mb
er
Co
rre
ct
Male true-
Female true-
Linear (Male true-)
Linear (Female true-)
True Positive Performance
y = -0.0438x + 27.029
R2 = 0.0617
y = -0.0418x + 26.746
R2 = 0.0605
1213141516171819202122232425
40.0 50.0 60.0 70.0 80.0 90.0 100.0
Age (years)
Nu
mb
er
Co
rre
ct
Male true+
Female true+
Linear (Male true+)
Linear (Female true+)
False Positives (incorrect guesses)
y = -0.0935x + 3.7674
R2 = 0.0153
y = -0.021x + 2.5605
R2 = 0.0007
0
2
4
6
8
10
12
6 8 10 12 14 16 18 20
Education (years)
Nu
mb
er
Wro
ng
Male False+
Female False+
Linear (Male False+)
Linear (Female False+)
False Negatives (memory failures)
y = -0.0042x + 1.4457
R2 = 3E-05
y = -0.0398x + 1.255
R2 = 0.02
0
2
4
6
8
10
12
6 8 10 12 14 16 18 20
Education (years)
Nu
mb
er
Wro
ng
Male False-
Female False-
Linear (Male False-)
Linear (Female False-)
Benefits of Early Alzheimer Diagnosis Social
Benefits of Early Alzheimer Diagnosis Social
Undiagnosed AD patients face avoidable problems • social, financial
Early education of caregivers• how to handle patient (choices, getting started)
Advance planning while patient is competent• will, proxy, power of attorney, advance directives
Reduce family stress and misunderstanding• caregiver burden, blame, denial
Promote safety• driving, compliance, cooking, etc.
Patient’s and Family’s right to know• especially about genetic risks
Promote advocacy• for research and treatment development
Benefits of Early Alzheimer Diagnosis Medical
Benefits of Early Alzheimer Diagnosis Medical
Early diagnosis and treatment and appropriate intervention may: improve overall course substantially lessen disease burden on caregivers / society
Specific treatments now available (anti-cholinesterases, memantine) Improve cognition Improve function (ADLs) Delay conversion from Mild Cognitive Impairment to AD Slow underlying disease process, the sooner the better Decreased development of behavior problems Delay nursing home placement, possibly over 20 months Delay nursing home placement longer if started earlier
Issues for Memory ScreeningIssues for Memory Screening
Current testing for memory problems is based on having a tester sit in front of a subject for a prolonged period of time and administer unpleasant tests
Testing must be Inexpensive (minimal need for administrator) Fun (so people will return for frequent
testing) More precise, reliable, and valid
• To improve sensitivity
• To improve specificity
Tests Available On-LineTests Available On-Line
www.memtrax.com
www.memtrax.net
www.medafile.com
www.cogolog.com
For further information, contact: Wes Ashford: [email protected]