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: washford@medafile.com