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CASE

Cognitive Assessment Scale for the Elderly


 

Daniel Geneau - Daniel Taillefer


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Overview of the CASE
Origins and brief description of the CASE
Development of the CASE
Psychometric properties
Standardization, administration and scoring
Normative data and interpretation guidelines
Appendix: List of Canadian Prime-Ministers and American Presidents
References


Literary revised by Anne Beaudoin, B.Sc. and Richard Rappoport, B.Sc.
Critically reviewed by Françoys Gagné, Ph.D.,
Dept. of Psychology, Université du Québec à Montréal
Material by Roger Marcotte, M.Ps.
Computer graphics by Caroline Ménard


Acknowledgements

The development of the CASE was rendered possible thanks to a research grant from Pfizer Canada. The authors wish to express their gratitude to a number of collaborators for their timely support and valuable assistance. The list includes by alphabetical order :
Dr. Marshal F. Folstein, MD - New England Medical Center, Boston, USA
Dr Françoys Gagné, PhD - Université du Québec à Montréal, Canada
Dr. Serge Gauthier, MD - McGill Centre for Studies in Aging, Montreal, Canada
Dr. Hillel Grossman, MD - New England Medical Center, Boston, USA
Dr. Vladimir Hachinski, MD - University of Western Ontario, London, Canada
Dr. Michel Panisset, MD - McGill Centre for Studies in Aging, Montreal, Canada
Dr. Thomas Tombaugh, PhD - Carleton University, Ottawa, Canada

We also wish to acknowledge the contributions of numerous research assistants in each site which the study was conducted.
Finally, we express our heartfelt thanks to Mrs. Hélène Beauchemin, coordinator of the CCFP/CMM for her unconditional support and her pivotal technical and organizational expertise.




Overview of the CASE

The Cognitive Assessment Scale for the Elderly (CASE) was created as a screening tool for the differential diagnosis of various cognitive impairments observable in many diseases associated with old age. It was specifically designed to offer a psychometrically valid compromise solution between very short screening instruments, like the Mini-Mental State Exam (MMSE) (Folstein et al., 1994) or the Cognitive Abilities Screening Instrument (CASI) (Teng et al., 1994), and complete neuropsychological assessment batteries, like the Luria-Nebraska (Christensen, 1975), Halstead-Reitan (Halstead, 1947) or the PENO (Joanette et al., 1989).


The Context of Dementia Assessment

Significant mental impairment is not a part of the normal aging process; its presence should be a signal for immediate action on the part of clinicians, the patients themselves and/or their family members (AHCPR, 1996). The cognitive deficits are no doubt the most characteristic sign of a large majority of cerebral diseases that affect elderly people. Because these deficits often manifest themselves in a very progressive way, early screening, as well as appropriate differential diagnostic pose a serious problem to health professionals.

An adequate clinical assessment of dementia combines three types of information: (a) details concerning the onset and progression of symptoms with relevant time frames, (b) an extensive physical examination, and (c) an evaluation of the status of mental functions. Studies have shown that from 20% to 70% of early cases of dementia, depending on the criteria used, are misdiagnosed (Pinholt et al., 1987; Roca et al., 1984). This is attributable in large part to the fact that the symptoms of dementia do not differ markedly in their early stages from normal cognitive degradation associated with old age (Wilson et al., 1997; Salmon & Bondi, 1997).

As mentioned above, the two most common forms of assessment of mental status are: (a) short screening tests like the MMSE or the CASI and (b) complete neuropsychological test batteries (Gauthier, 1998). Both techniques have advantages and disadvantages. In the case of neuropsychological batteries, depth of analysis and profile differentiation are no doubt the main advantages. But, apart from the high costs involved to obtain such detailed information, these lengthy procedures have other practical drawbacks. First, small clinics that are not linked with major universities or research centers often do not have enough qualified personnel to administer these specialized tests and interpret their results (Teng et al., 1994). Second, older patients often find the procedure stressful and do not collaborate as positively as required, thus affecting the validity of the information.

For their part, short screening techniques offer the advantages of limited costs and ease of administration, but at the cost of lower sensitivity and precision, especially in the case of light dementia symptoms shown by non-institutionalized individuals (Tombaugh & McIntyre, 1992; Brayne & Calloway, 1990).

Being a minimally invasive, easy-to-use instrument with a reasonable administration time and good psychometric properties, the CASE is appropriate in the screaning and evaluation of pathological cognitive deficits in the elderly individual.

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Origins and brief description of the CASE

The precursor of the CASE is a French-Canadian instrument called PECPA (Protocole d’examen cognitif de la personne âgée), originally created in 1994 (Geneau & Taillefer, 1995). Using a revised version of the MMSE (Folstein et al., 1975) as their starting point, the authors built a more detailed instrument covering ten distinct cognitive abilities (see below). The second revised version of that instrument (PECPA-2r) was validated and normed on a large sample of elderly non-institutionalized Francophone Quebecers (n = 282); it showed test-retest reliability indices of 0,93, sensitivity indices varying between 94% and 100%, as well as specificity indices of 95% and above (Geneau & Taillefer, 1996).

The CASE is an adapted translation of the PECPA-2r. It is composed of 103 items (see chapter 5), grouped into ten different cognitive ability categories: (1) Temporal Orientation; (2) Spatial Orientation; (3) Attention-Concentration and Calculation; (4) Immediate Recall; (5) Language (6) Remote Memory; (7) Judgment and Abstraction; (8) Agnosia; (9) Apraxia; (10) Recent Memory. Each set of tasks produces a score on a 10-point scale, plus an overall score varying from 0 to 100. The MMSE items are distributed in the above categories.

The CASE takes approximately 45 minutes to administer. It is a copyrighted instrument: but the materials and directions in chapter 5 are reproducible as well as the scoring sheet and the five answer sheets in the Appendix 1 and 2 . The scoring sheet offers not only a summary table of the results, but also a cognigram, or cognitive efficiency profile, that illustrates areas of deterioration. Normative data (see Chapter 6) permit comparisons with normal subjects in various age and education groups, as well as with subjects diagnosed with an organic cerebral syndrome.

Thanks to a generous research grant from the Pfizer pharmaceutical company, the CASE was subjected to an extensive process of validation and normalization, with samples of subjects in various geographical areas, both in Canada and the United States (see Chapter 3).

Uses and limitations of the CASE

The diverse potential uses of the CASE include :

Screening of organic brain syndromes in the elderly

The CASE features the capacity to distinguish the normal aging process and light deficits related to cerebral morbidity. It serves in the detection of pathological cognitive loss in the elderly who suffer from cerebral organic syndrome. The scale is equally able to provide a profile of cognitive deterioration and to help in the diagnosis process.

However, the CASE sub-tests don't directly measure cognitive functions. The abilities measured by the scale imply many cognitive mechanisms (ex.: encoding, consolidation, lexical facility, naming, conceptualization, etc.). From this perspective, even if many health professionals can use theCASE in their clinical evaluations, it would require a qualified clinician to determine the nature of the cognitive impairment and to offer a diagnostic opinion. In his interpretation, this individual must take into account every other clinical measures, the anamnestic informations and the medical and psychological status of the subject under investigation.

Monitoring interventions

Similarly, the CASE could be used to take a series of measures during the course of a pathological condition, or will provide verification of the effectiveness of any particular therapeutic intervention.

Specific use in clinical trials

There is no theoretical objection to the utilization of an instrument such as the CASE in the measurement of cognitive functionning of the elderly patient participationg in clinical pharmacological trials (Brouwers and Mohr, 1989). This strategy is recommended because it allows for a better evaluation of baseline of outcome measures. It however requires the use of complex statistical methods to interpret the data (Kroke and Hawking, 1985). Moreover, CASE scores could be used in clinical trials as part of the inclusion-exclusion criteria process (Brouwers and Mohr, 1991; Morris and Thompson, 1991).

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Development of the CASE

This version of the CASE has undergone a validation procedure and a North-American multi-centric normalization developped through Canadian and American samples.

SUBJECTS

All normal subjects (N=359) were recruited in Boston, London (Ontario) and Montreal by appeal or through a reference network. The subjects were divided into eight groups according to age and education level. Table 1 presents the distribution of the subjects in the eight normal groups. The ages of the normal subjects varied between 60 and 95 years (mean of 74,1 and a standard deviation of 7,0). Their education level was between 0 and 24 years (mean of 11,7 and a standard deviation of 3,9). Table 2 presents those variables and the MMSE and CASE scores for each site.

EDUCATION

Age 60 to 74

Age 75 or more

TOTAL

0 to 7

N = 27

N = 24

51

8 to 11

N = 64

N = 48

112

12 to 14

N = 60

N = 58

118

15 or more

N = 35

N = 43

78

TOTAL

186

173

359

Table 1: Normal group distribution according to age and education level.

To be part of the sample, the normal subjects had to meet the following specific inclusion criteria:

  • to be living independently ;
  • to be fluent in English ;
  • to have the visual acuity sufficient to read a written sentence ;
  • to have sufficient hearing, so as to be able to repeat a sentence.

 

Montreal

London

Boston

N

229

66

64

Age

73.0 (6.8)

75.7 (6.3)

76.3 (7.8)

Education

10.4 (3.6)

14.0 (3.7)

13.9 (2.8)

MMSE

28.4 (1.5)

29.0 (1.3)

28.9 (1.2)

CASE

92.5 (6.6)

94.5 (5.2)

93.0 (5.6)


Table 2: Age, education level, MMSE and CASE scores for all normal subjects.

In order to control some of co-morbidity factors, subjects responding to the following exclusion criteria were be rejected at a pre-selection level or at the post-administration step.

Exclusion criteria (at least one) :


  • Illiteracy ;
  • being blind or deaf ;
  • complaining of memory problems ;
  • reporting a history of neurological or psychiatric illness ;
  • using a psychotropic medicine at major dose ;
  • achieving a score lower than 23 on the MMSE ;
  • achieving a score higher than 12 on the GDS (Geriatric Depression Scale ; Brinks, 1982).

Following a thorough medical evaluation, the cognitive impaired subjects (n=67) were diagnosed of suffering from a dementia syndrome due to a variety of brain diseases. The diagnosis must not have been made more than six months prior to the testing, thus avoiding the clinical picture to be more severe than at the level at which a diagnostic tool is required. No specific " Age " or " Educational Backgrounds " variables have been included in relation with the cognitive impairment subjects.


Diagnosis

N

Dementia of the Alzheimer type

33

Vascular dementia

14

Mixed dementia

1

Fronto-temporal dementia

1

Alcoholic dementia

1

Korsakoff’s syndrome

1

Normal pressure hydrocephalus

1

Dementia of undetermined etiology at time of exam

15


Table 3: Diagnosis for all cognitively impaired subjects (N=67).


Table 3 presents the diagnosis for the 67 cognitively impaired subjects. Ages varied between 59 and 96 years (mean of 77,9 and a standard deviation of 7,3) and education level being between 0 and 20 years (mean of 10,0 and a standard deviation of 3,9).

Method

Recruitment of the normal subjects responding to the inclusion criteria has been achieved through advertising, social groups and word of mouth. This procedure follows the " convenience normal subjects sampling " using a networking model as described by Tombaugh and Schmidt (1992).

Testing of normal subjects was performed at home using the CASE and the GDS. By means of an interview, the examiner supported them in the completion of a self-report medical history questionnaire and gathered information pertaining to the subject's professional, social and educational background. Administration of the GDS and the CASE followed immediately (total duration : 1h30).

Cognitively impaired subjects were interviewed at home, hospital or research center and administered the CASE. All other relevant information was retrieved from medical files.

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Psychometric properties

The CASE discriminative levels of normality according to age and education are issued from values of significant samples. The weighted scores according to those variables for a North-American population have not deviate significantly from those obtained in the original PECPA-2r normalization study (Geneau & Taillefer, 1996). Summarized cut-off scores are presented in Table 4.

Reliability

The CASE reliability coefficient was estimated with the Spearman-Brown formula through a split-half procedure with all subjects. The reliability coefficient (0.95) indicated a very high internal consistency.

Validity

The CASE concurrent validity is demonstrated by its capacity to discriminate the normal subjects from those with a diagnosis of organic brain syndrome.

Upon the discriminating criteria used, that is, a) a global score of less than 80 on the CASE; b) a cognigram containing three or more sub-tests with a score of 7 or less; c) a total score standardized for age and education level, the sensitivity varied between 0.85 and 0.91 and the specificity between 0.95 and 0.97. The total standardized score has proven to be the most discernating criteria and its use is strongly recommended. Table 5 presents the validity coefficients obtained in regard to the discriminating criteria used.


 

EDUCATION

Age 60 to 74

Age 75 or more

0 to 7

75

75

8 to 11

75

75

12 to 14

80

80

15 or more

85

80


Table 4: CASE cut-off scores according to age and education level.


Discriminating criteria

Sensitivity

Specificity

Precision

Score of < 80

0.91

0.95

0.86

3 to 10 sub-tests < 7

0.85

0.96

0.82

Standardised scores

0.90

0.97

0.87


Table 5: CASE validity coefficients in relation to the discriminating criteria.


The MMSE concurrent validity was measured from the same samples. Using the score of 23 recommended by Folstein et al. (1975), the sensitivity and the specificity were measured at 0.61 and 0.99 respectively. Considering a cut-off score of 26, the sensitivity rises to 0.85 and the specificity to 0.92, for a precision of 0.78.

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Standardization, administration and scoring

To properly use the CASE, the examiner must follow the standardized procedure of the Administration and Scoring Guide found on pages 15-18.

General Considerations

The evaluation setting should have proper lighting, be well ventilated and be free of all distractions. The subject should be comfortably seated at a table with a smooth, flat surface of proper height. The examiner must always verify that the subject has adequate vision and hearing. The material booklet should remain out of sight until needed.

The examiner should be sufficiently familiar with the administration procedure so as to, without hesitation, be able to follow the manual, observe the subject and record his answers.

The directions contained in the Administration Guide section should be adhered to as closely as possible. It is however acceptable to restate a question in order to provide clarification as long as the examiner does not prompt or direct the answer. Scoring of the CASE must be done according to the criteria defined in the Administration and Scoring Guide.

Appendix 3 provides a list of Canadian Prime-Ministers and American Presidents which could be of use in scoring the remote memory CASE sub-test .

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Normative data and interpretation guidelines

The use of normative data allows to compare the performance of one individual to group of people with the same age and education level. Table 6 describes the scores obtained by all groups for the MMSE and the CASE.


AGE

N

MMSE

CASE

Education level 0 - 7 years
60 - 74 years

27

27.6 (1.5)

88.9 (7.4)

75 years +

24

27.5 (2.0)

87.0 (7.9)

Education level 8 - 11 years
60 - 74 years

64

28.8 (1.3)

93.7 (4.9)

75 years +

48

28.3 (1.5)

90.3 (7.4)

Education level 12 - 14 years
60 - 74 years

60

29.1 (1.0)

95.6 (4.4)

75 years +

58

28.7 (1.4)

93.1 (5.1)

Education level 15 years +
60 - 74 years

35

29.0 (1,0)

97.3 (2.2)

75 years +

43

28.9 (1.2)

93.0 (6.1)

Subjects with cognitive impairments
 

67

21.8 (4.8)

62.1 (16.0)


Table 6: MMSE and CASE mean scores and standard deviations for all groups.


Table 7 shows the mean scores and standard deviations obtained for each group across the ten CASE sub-tests. Tables 8a and 8b allows for conversion of the MMSE and CASE raw scores to percentile ranks (global scores and sub-tests), according to age and education level.

Interpretation guidelines

Any attempt to present an etiological diagnosis by using only the CASE is not recommended. This procedure should be supported by a multidisciplinary investigation and a clinical exam by a psychiatrist, neurologist or geriatrician, extended neuropsychological assessment, brain imaging, laboratory tests, etc. The CASE is the first step of a process of detection and evaluation of deficits in cognitive functionning.

The results are usually interpreted according to three levels of analysis: 1) the total score alone, 2) the profile of cognitive functionning with the cognigram and 3) a qualitative analysis of all the sub-tests of the scale. The last two levels should allow to conclude to the presence of cognitive deficits that are clinically significant or to attribute them to variations in normal aging.

The interpretation of the CASE scores will depend, in large part, on the comparison between these scores and the data presented in the manual with regard to those normal individuals of the same age and educational background. One may conclude of a pathological cognitive deficit if the scores diverge significantly from the scores obtained by the normal control groups. If however the results fall within a normal range, they may be considered as a reflection of variations in the normal process of cognitive aging.


AGE

TO

SO

ACC

IR

L

Rem

JA

Ag

Ap

Rec

Education level 0 - 7 years

60-74 yrs

9.7 (0.5)

9.7 (0.5)

8.0 (1.9)

9.4 (0.8)

8.8 (1.4)

9.4 (1.0)

8.4 (1.3)

9.0 (1.8)

7.7 (1.5)

8.7 (1.5)

75 yrs >

9.8 (0.4)

9.8 (0.4)

8.2 (1.8

8.8 (1.5)

8.2 (1.0)

9.3 (0.9)

8.4 (1.4)

8.8 (1.5)

7.1 (2.0)

8.4 (2.0)

Education level 8 - 11 years

60-74 yrs

9.8 (0.4)

9.8 (0.4)

9.1 (1.3)

9.6 (0.7)

9.1 (0.9)

9.7 (0.6)

9.0 (1.2)

9.4 (1.3)

8.8 (1.2)

9.3 (1.0)

75 yrs >

9.8 (0.5)

9.8 (0.5)

8.9 (1.5)

9.2 (1.3)

8.8 (1.0)

9.7 (0.6)

8.7 (1.5)

9.0 (1.6)

8.2 (1.8)

8.4 (1.7)

Education level 12 - 14 years

60-74 yrs

9.8 (0.4)

9.9 (0.3)

9.5 (0.9)

9.8 (0.4)

9.5 (0.6)

9.9 (0.2)

9.2 (1.1)

9.5 (1.0)

8.9 (1.4)

9.4 (0.7)

75 yrs >

9.8 (0.5)

9.9 (0.4)

9.3 (1.1

9.5 (0.8)

8.9 (1.0)

9.7 (0.6)

9.1 (1.1)

9.1 (1.5)

8.5 (1.3)

9.3 (0.8)

Education level 15 years or >

60-74 yrs

9.7 (0.5)

9.9 (0.2)

9.6 (0.9)

9.8 (0.5)

9.7 (0.6)

9.9 (0.2)

9.6 (0.6)

9.9 (0.2)

9.4 (0.9)

9.5 (0.6)

75 yrs >

9.9 (0.4)

9.9 (0.3)

9.1 (1.3)

9.5 (0.9)

9.2 (1.0)

9.7 (0.6)

9.1 (1.0)

9.1 (1.6)

8.5 (1.8)

9.0 (1.3)

Subjects with cognitive impairments
 

7.2 (2.2)

8.3 (2.1)

5.9 (2.8)

6.1 (2.0)

6.0 (2.1)

7.5 (1.9)

5.8 (2.2)

6.4 (3.0)

5.7 (2.2)

3.4 (2.7)


Table 7: CASE sub-tests mean scores and standard deviations obtained for all groups.


Age 60 to 74

Education level

0 - 7 years

8 - 11 years

12 - 14 years

15 years or more

Percentiles

10

25

50

75

90

10

25

50

75

90

10

25

50

75

90

10

25

50

75

90

MMSE

25

27

27

29

30

27

28

29

30

30

27

29

30

30

30

28

28

29

30

30

CASE

74.5

89.0

91.0

93.0

95.5

86.0

90.5

95.0

97.0

99.0

92.0

94.0

96.0

98.0

99.5

93.5

97.0

98.0

99.0

99.0

Temporal Orientation

9

9

10

10

10

9

10

10

10

10

9

10

10

10

10

9

10

10

10

10

Spatial Orientation

9

9

10

10

10

9

10

10

10

10

9

10

10

10

10

10

10

10

10

10

Att. Conc. and Calculation

5

7

8

9.5

10

7.5

8.5

10

10

10

8

9.5

10

10

10

8

9.5

10

10

10

Immediate Recall

8

9

10

10

10

8

9

10

10

10

9

10

10

10

10

9

10

10

10

10

Language

6.5

8

9

10

10

7.5

8.5

9

10

10

8.5

9

9.5

10

10

9

9.5

10

10

10

Remote Memory

8

9

10

10

10

9

10

10

10

10

10

10

10

10

10

10

10

10

10

10

Judgment and Abstraction

7

8

8

9

10

7

8

9

10

10

8

8

10

10

10

9

9

10

10

10

Agnosia

6

9

10

10

10

8

9

10

10

10

8

9

10

10

10

10

10

10

10

10

Apraxia

5

6

8

9

10

7

8

9

10

10

7

8

9

10

10

8

9

10

10

10

Recent Memory

6

8

9

10

10

8

9

10

10

10

8

9

10

10

10

9

9

10

10

10


Table 8a: MMSE and CASE raw scores conversion table to percentile ranks for age 60 - 74.


Age 75 or more

Education level

0 - 7 years

8 - 11 years

12 - 14 years

15 years or more

Centiles

10

25

50

75

90

10

25

50

75

90

10

25

50

75

90

10

25

50

75

90

MMSE

24

27

28

29

29

26

28

29

29

30

27

28

29

30

30

27

28

29

30

30

CASE

75.0

82.5

89.0

92.5

93.5

80.5

86.0

91.5

96.5

99.0

85.5

91.0

94.5

97.0

97.5

85.0

91.5

94.0

98.0

99.0

Temporal Orientation

9

10

10

10

10

9

10

10

10

10

9

10

10

10

10

9

10

10

10

10

Spatial Orientation

9

10

10

10

10

9

10

10

10

10

9

10

10

10

10

10

10

10

10

10

Att. Conc. and Calculation

5

6.5

8.5

10

10

6

8

9.5

10

10

8

9

10

10

10

7.5

8

10

10

10

Immediate Recall

6

8

9

10

10

7

9

10

10

10

8

9

10

10

10

8

9

10

10

10

Language

6.5

7.5

8.5

9

9.5

7.5

8

9

10

10

8

8.5

9

10

10

8

9

9.5

10

10

Remote Memory

9

9

9

10

10

9

9

10

10

10

9

10

10

10

10

9

10

10

10

10

Judgment and Abstraction

7

8

9

9

10

6

8

9

10

10

7

9

9

10

10

8

8

9

10

10

Agnosia

6

8

9

10

10

7

9

10

10

10

7

9

10

10

10

8

9

10

10

10

Apraxia

4

5

7

9

9

5

9

9

10

10

7

8

9

10

10

5

8

9

10

10

Recent Memory

4

8

9

10

10

6

8

9

10

10

8

9

9

10

10

8

8

9

10

10


Table 8b: MMSE and CASE raw scores conversion table to percentile ranks for age 75 or more.


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Appendix

List of Canadian Prime-Ministers

John Macdonald
Alex. Mackenzie
John Abbott
John Thompson
Mackenzie Bowell
Charles Tupper
Wilfrid Laurier
Robert Laird Borden
Arthur Meighen
William Lyon Mackenzie King
Richard B. Bennett
Louis-S. Saint-Laurent
John-George Diefenbaker
Lester B. Pearson
Pierre-Eliott Trudeau
Joe Clark
John Turner
Brian Mulroney
Kim Campbell
Jean Chrétien
Stephen Harper

List of American Presidents

George Washington
John Adams
Thomas Jefferson
James Madison
James Monroe
John Quincy adams
Andrew Jackson
Martin van Buren
William Henry Harrison
John Tyler
James K. Polk
Zachary Taylor
Millard Fillmore
Franklin Pierce
James Buchanan
Abraham Lincoln
Andrew Johnson
Ulysses S. Grant
Rutherford B. Hayes
James Garfield
Chester A. Arthur
Grover Cleveland
Benjamin Harrison
William McKinley
Theodore Roosevelt
William Howard Taft
Woodrow Wilson
Warren Harding
Calvin Coolidge
Herbert Hoover
Franklin D. Roosevelt
Harry S. Truman
Dwight D. Eisenhower
John F. Kennedy
Lyndon B. Johnson
Richard M. Nixon
Gerald R. Ford
Jimmy Carter
Ronald Reagan
George H. W. Bush
Bill Clinton
George W. Bush
Barack Obama

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References

AGENCY FOR HEALTH CARE POLICY AND RESEARCH. (1996). Early Alzheimer disease : a guide for patients and families. Publications Clearinghouse. Pp. 594-1364.

BRAYNE, C. & CALLOWAY, P. (1990). The case identification of dementia in the community : a comparison of methods. International Journal of Geriatric Psychiatry, 5, 309-316.

BRINKS, T. L., YESAVAGE, T. L., LUM, O., HEERSMA, P. H., ADEY, M., ROSE, T. L. (1982). Screening tests for geriatric depression. Clinical Gerontologist, 1: 37-44.

BROUWERS, P. & MOHR, E. (1991). Design in clinical trials in Handbook of clinical trials : the neurobehavioral approach, Mohr, E. & Brouwers, P. (eds), Amsterdam : Swets & Seitlinger, pp.45-66.

BROUWERS, P. & MOHR, E. (1989). A metric for the evaluation of change in clinical trials. Clinical Neuropsychology, 12, 129-133.

CHRISTENSEN, A. L. (1975). Luria's neuropsychological invertigation. New-York : Spectrum Publications.

FOLSTEIN, M. F., FOLSTEIN, S. E., McHUGH, P. R. (1975). " Mini-Mental Test ": A practical method for grading the cognitive state of patients for the clinician. J. Psychiatry Res., 12: 189-198.

GAUTHIER, S. (1997). Étude sur la santé et le vieillissement au Canada : son impact sur la maladie d'Alzheimer in Revue Canadienne de la maladie d'Alzheimer, 1, 1, pp : 8-11.

GENEAU, D., TAILLEFER, D. (1995). Le Protocole d'Examen Cognitif de la Personne Âgée (PECPA-2). Allocution présentée au 1er Colloque de Psychogériatrie du C.C.F.P., St-Hyacinthe, Québec.

GENEAU, D., TAILLEFER, D. (1996). Le "Protocole d'Examen Cognitif de la Personne Âgée - Version Révisée" (PECPA-2r): Normalisation par groupes d'âge et antécédents éducationnels chez des sujets québécois francophones. Allocution présentée au 2ième Colloque de Psychogériatrie du C.C.F.P., St-Hyacinthe, Québec.

HALSTEAD, W. C. (1947). Brain and intelligence. Chicago : University of Chicago press.

JOANETTE, Y., POUSSANT, A., SKA, B., FONTAINE, F. S. (1989). PENO : protocole d'évaluation neuropsychologique optimal. Montréal, Laboratoire Théophile-Alajouanine.

MORRIS, R. D. & THOMPSON, N. J. (1991). Patient screening and inclusion criteria in Handbook of clinical trials : the neurobehavioral approach, Mohr, E. & Brouwers, P. (eds), Amsterdam : Swets & Seitlinger, 29-44.

Pinholt, E.M., Kroenke, K., Hanley, J.F., et COLL. (1987). Functional assessment of the elderly: a comparison of standard instruments with clinical judgement. Arch Intern Med; 147: 484-8.

REITAN, R. M. & DAVISON, L. A. (1974). Clinical neuropsychology : current status and applications. New-York : Winston/Wiley.

ROCA, R.P., KLEIN, L.E., KIRBY, S.M. ET AL. (1984). Recognition of dementia among medical patients. Arch Intern Med, 144:73-5.

SALMON, P.D. & BONDI, W. W. (1997). The neuropsychology of Alzheimer's disease in Handbook of Neuropsychology and Aging, Nussbaum, P. D. : ed., New-york : Plenum Press.

TAILLEFER, D., GENEAU, D. (en préparation). Normalisation et validation d'une version française du MMSE chez une population québécoise francophone selon l'âge et la scolarité: données préliminaires.

TENG, E. L., Hasegawa, K., Homma, A., Imai, Y., Larson, E., Graves, A., Sugimoto, K., Yamaguchi, T., Sasaki, H., Chiu, D., et al. (1994). The Cognitive Abilities Screening Instrument (CASI): a practical test for cross-cultural epidemiological studies of dementia. Int-Psychogeriatr, 6(1), 45-58.

TOMBAUGH, T. N., McINTYRE, N. J. (1992). The Mini-Mental State Examination: A Comprehensive Review. J. Am. Geriatric. Soc., 40: 922-935.

VON GUTEN, A., DUC, R., BRULL, J., KÜNG, A., TAILLEFER, D. & GENEAU, D. (In preparation). French version and standardization of the Cognitive Assessment Scale for the Elderly in Switzerland.

WILSON, R.S., Bennett, D. A., Swartgendauler, A. (1997). Age-related change in cognitive function in Handbook of Neuropsychology and Aging, Nussbaum, P. D. : ed., New-york : Plenum Press.

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