The identification of cognitive subtypes in Alzheimer's disease dementia using latent class analysis

Nienke M E Scheltens; Francisca Galindo-Garre; Yolande A L Pijnenburg; Annelies E van der Vlies; Lieke L Smits; Teddy Koene; Charlotte E Teunissen; Frederik Barkhof; Mike P Wattjes; Philip Scheltens; Wiesje M van der Flier

doi:10.1136/jnnp-2014-309582

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Neurodegeneration

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The identification of cognitive subtypes in Alzheimer's disease dementia using latent class analysis

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Re:New Insights on AD: Comment on The identification of cognitive subtypes in Alzheimer's disease dementia using latent class analysis
Nienke M.E. Scheltens
Published on: 12 May 2015
New Insights on AD: Comment on The identification of cognitive subtypes in Alzheimer's disease dementia using latent class analysis
Ashima Nehra
Published on: 21 April 2015

Published on: 12 May 2015
Re:New Insights on AD: Comment on The identification of cognitive subtypes in Alzheimer's disease dementia using latent class analysis
- Nienke M.E. Scheltens, MD, PhD Student
- Other Contributors:
  Wiesje M. van der Flier
Thank you for your enthusiasm for our study, and for your questions.
In our opinion, an extensive neuropsychological test battery is mandatory for diagnosis of probable AD dementia. An MMSE score alone is not sufficient for the assessment of cognitive impairment.
We used MMSE as indicator for disease severity, within our sample of already diagnosed probable AD patients. It is an interesting suggestion t...
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Thank you for your enthusiasm for our study, and for your questions.
In our opinion, an extensive neuropsychological test battery is mandatory for diagnosis of probable AD dementia. An MMSE score alone is not sufficient for the assessment of cognitive impairment.
We used MMSE as indicator for disease severity, within our sample of already diagnosed probable AD patients. It is an interesting suggestion to use the MoCA for this purpose, because this test focuses more on several non-memory domains. However, we preferred MMSE because it is commonly used and easy to interpret.
Mean age of the patients in our cohort was 69+/-9 years old (shown in table 1). Mean ages per cluster are given in table 4.
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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Published on: 21 April 2015
New Insights on AD: Comment on The identification of cognitive subtypes in Alzheimer's disease dementia using latent class analysis
- Ashima Nehra, Assistant Professor
- Other Contributors:
  Harsimarpreet Kaur, Sakshi Chopra
We read with interest the recent article published by Scheltens et. al. [1] The article helped us in understanding greater insights about AD dementia. As rightly stated by the authors that one magic bullet will never be found, but different therapeutic agents may benefit different subgroups of patients. The identification and importance of cognitive AD subtypes for making differentiated diagnoses will also help in the fu...
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We read with interest the recent article published by Scheltens et. al. [1] The article helped us in understanding greater insights about AD dementia. As rightly stated by the authors that one magic bullet will never be found, but different therapeutic agents may benefit different subgroups of patients. The identification and importance of cognitive AD subtypes for making differentiated diagnoses will also help in the further cognitive rehabilitation of AD patients. Out of the three clusters classified by the authors, one was the memory indifferent group wherein all patients were diagnosed with probable AD with a MMSE score with mean 14. The review suggests how an MMSE score is not supportive of AD diagnosis. [2][3] We would like to know the view of the authors on how memory indifferent group a MMSE score. As the neuropsychological test battery used by the institute is dynamic, the use of MMSE in future can be avoided as it is not a sensitive measure for diagnosis of AD. There are other available measures which are found to be more sensitive than MMSE for cognitive screening like MoCA. [4][5]Attention is one of the cognitive domains that are found to be impaired in people suffering from AD. [6] It's intriguing to know from the results of the paper which show how attention is comparatively less affected in these patients. Lastly, we would like to know the age of the patients as the article talks about the younger patients who were six times more likely to be classified in MOD- VISP, three times likely to be classified in SEV-DIFF and two times likely to be classifies in MILD-EXE. The information about the different age ranges would provide a better insight. We would like to thank the authors for carrying out this research as it provides greater understanding of the AD.
1. Scheltens, N. M., Galindo-Garre, F., Pijnenburg, Y. A., van der Vlies, A. E., Smits, L. L., Koene, T., & van der Flier, W. M. (2015). The identification of cognitive subtypes in Alzheimer's disease dementia using latent class analysis. Journal of Neurology, Neurosurgery & Psychiatry, jnnp-2014. 2. Roselli, F., Tartaglione, B., Federico, F., Lepore, V., Defazio, G., & Livrea, P. (2009). Rate of MMSE score change in Alzheimer's disease: influence of education and vascular risk factors. Clinical neurology and neurosurgery, 111(4), 327-330. 3. Galasko, D., Klauber, M. R., Hofstetter, C. R., Salmon, D. P., Lasker, B., & Thal, L. J. (1990). The Mini-Mental State Examination in the early diagnosis of Alzheimer's disease. Archives of Neurology, 47(1), 49- 52. 4. Neufang, S., Akhrif, A., Riedl, V., F?rstl, H., Kurz, A., Zimmer, C., & Wohlschl?ger, A. M. (2011). Disconnection of frontal and parietal areas contributes to impaired attention in very early Alzheimer's disease. Journal of Alzheimer's Disease, 25(2), 309-321. 5. Pendlebury, S. T., Markwick, A., de Jager, C. A., Zamboni, G., Wilcock, G. K., & Rothwell, P. M. (2011). Differences in cognitive profile between TIA, stroke and elderly memory research subjects: a comparison of the MMSE and MoCA. Cerebrovascular diseases (Basel, Switzerland), 34(1), 48-54. 6. Larner, A. J. (2012). Screening utility of the Montreal Cognitive Assessment (MoCA): in place of-or as well as-the MMSE?. International Psychogeriatrics, 24(3), 391. 7. Calderon, J., Perry, R. J., Erzinclioglu, S. W., Berrios, G. E., Dening, T., & Hodges, J. R. (2001). Perception, attention, and working memory are disproportionately impaired in dementia with Lewy bodies compared with Alzheimer's disease. Journal of Neurology, Neurosurgery & Psychiatry, 70(2), 157-164.
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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