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The Alzheimer’s Disease Assessment Scale-Cognitive-Plus (ADAS-Cog-Plus): an expansion of the ADAS-Cog to improve responsiveness in MCI

  • ADNI: FRIDAY HARBOR 2011 WORKSHOP SPECIAL ISSUE
  • Published:
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Abstract

Background

The Alzheimer’s Disease Assessment Scale cognitive subscale (ADAS-Cog) is widely used in AD, but may be less responsive to change when used in people with mild cognitive impairment (MCI).

Methods

Participants from the Alzheimer’s Disease Neuroimaging Initiative were administered a neuropsychological battery and 1.5 T MRI scans over 2–3 years. Informants were queried regarding functional impairments. Some participants had lumbar punctures to obtain cerebrospinal fluid (CSF). We added executive functioning (EF) and functional ability (FA) items to the ADAS-Cog to generate candidate augmented measures. We calibrated these candidates using baseline data (n = 811) and selected the best candidate that added EF items alone and that added EF and FA items. We selected candidates based on their responsiveness over three years in a training sample of participants with MCI (n = 160). We compared traditional ADAS-Cog scores with the two candidates based on their responsiveness in a validation sample of participants with MCI (n = 234), ability to predict conversion to dementia (n = 394), strength of association with baseline MRI (n = 394) and CSF biomarkers (n = 193).

Results

The selected EF candidate added category fluency (ADAS Plus EF), and the selected EF and FA candidate added category fluency, Digit Symbol, Trail Making, and five items from the Functional Assessment Questionnaire (ADAS Plus EF&FA). The ADAS Plus EF& FA performed as well as or better than traditional ADAS-Cog scores.

Conclusion

Adding EF and FA items to the ADAS-Cog may improve responsiveness among people with MCI without impairing validity.

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Acknowledgments

Elizabeth Sanders prepared the structural model graphics. S. McKay Curtis provided the methods and R code for the bi-factor information curves.

Analyses were supported by NIH grants 5T32AG000258 (J Skinner), R13 AG030995 (Mungas), P50 AG05136 (L Gibbons), R01 AG 029672 (P Crane, L Gibbons), R01 AG 10569 (E Zelinski), and P50 AG005142 (E Zelinski) from the National Institute on Aging, and T32MH19535 (A Thames) and K23MH087741 (Potter) from the National Institute on Mental Health.

Financial disclosure

None reported.

Funding support

ADNI is funded by the National Institute on Aging, the National Institute of Biomedical Imaging and Bioengineering, and through generous contributions from the following: Abbott; Alzheimer’s Association; Alzheimer’s Drug Discovery Foundation; Amorfix Life Sciences Ltd.; AstraZeneca; Bayer HealthCare; BioClinica, Inc.; Biogen Idec Inc.; Bristol-Myers Squibb Company; Eisai Inc.; Elan Pharmaceuticals Inc.; Eli Lilly and Company; F. Hoffmann-LaRoche Ltd and its affiliated company Genentech, Inc.; GE Healthcare; Innogenetics, N.V.; Janssen Alzheimer’s Immunotherapy Research & Development, LLC.; Johnson & Johnson Pharmaceutical Research & Development LLC.; Medpace, Inc.; Merck & Co., Inc.; Meso Scale Diagnostics, LLC.; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Servier; Synarc Inc.; and Takeda Pharmaceutical Company. The Canadian Institutes of Health

Additional information

*Data used in preparation of this article were obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database (adni.loni.ucla.edu). As such, the investigators within the ADNI contributed to the design and implementation of ADNI and/or provided data but did not participate in analysis or writing of this report.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA

    Jeannine Skinner

  2. Alpert Medical School, Brown University, Providence, RI, USA

    Janessa O. Carvalho

  3. Department of Psychiatry and Behavioral Sciences, Duke University, Durnham, NC, USA

    Guy G. Potter

  4. Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA

    April Thames

  5. Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA

    Elizabeth Zelinski

  6. Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA

    Paul K. Crane & Laura E. Gibbons

  7. Veterans Administration Puget Sound Health Care System, 1660 South Columbian Way, Box 358280, Seattle, WA, 98118, USA

    Jeannine Skinner

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Skinner, J., Carvalho, J.O., Potter, G.G. et al. The Alzheimer’s Disease Assessment Scale-Cognitive-Plus (ADAS-Cog-Plus): an expansion of the ADAS-Cog to improve responsiveness in MCI. Brain Imaging and Behavior 6, 489–501 (2012). https://doi.org/10.1007/s11682-012-9166-3

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