A Neuropsychological Perspective on Defining Cognitive Impairment in the Clinical Study of Alzheimer’s Disease: Towards a More Continuous Approach

Author:

Jutten Roos J.1,Thompson Louisa23,Sikkes Sietske A.M.4,Maruff Paul5,Molinuevo José Luis67,Zetterberg Henrik891011,Alber Jessica1213,Faust David14,Gauthier Serge15,Gold Michael16,Harrison John41718,Lee Athene K.W.23,Snyder Peter J.12

Affiliation:

1. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

2. Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA

3. Memory and Aging Program, Butler Hospital, Providence, RI, USA

4. Alzheimer Center Amsterdam, Department of Neurology, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands

5. The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia

6. Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain

7. Alzheimer’s Disease and Other Cognitive Disorders Unit, Hospital Clinic, Barcelona, Spain

8. Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden

9. Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden

10. Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK

11. UK Dementia Research Institute at UCL, London, UK

12. Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, The University of Rhode Island, Kingston, RI, USA

13. George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, USA

14. Department of Psychology, University of Rhode Island, Kingston, RI, USA

15. McGill Centre for Studies in Aging, Montréal, Canada

16. AbbVie Inc., North Chicago, IL, USA

17. Metis Cognition Ltd, Kilmington Common, UK

18. Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK

Abstract

The global fight against Alzheimer’s disease (AD) poses unique challenges for the field of neuropsychology. Along with the increased focus on early detection of AD pathophysiology, characterizing the earliest clinical stage of the disease has become a priority. We believe this is an important time for neuropsychology to consider how our approach to the characterization of cognitive impairment can be improved to detect subtle cognitive changes during early-stage AD. The present article aims to provide a critical examination of how we define and measure cognitive status in the context of aging and AD. First, we discuss pitfalls of current methods for defining cognitive impairment within the context of research shifting to earlier (pre)symptomatic disease stages. Next, we introduce a shift towards a more continuous approach for identifying early markers of cognitive decline and characterizing progression and discuss how this may be facilitated by novel assessment approaches. Finally, we summarize potential implications and challenges of characterizing cognitive status using a continuous approach.

Publisher

IOS Press

Subject

Psychiatry and Mental health,Geriatrics and Gerontology,Clinical Psychology,General Medicine,General Neuroscience

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