I test neuropsicologici nelladiagnosi del disturbo

cognitivo

Stefano F. Cappa

Istituto Universitario Studi Superiori e

Fondazione Mondino

Pavia

Evoluzione del ruolo diagnostico dellaneuropsicologia nel disturbo cognitivo: il casodella malattia di Alzheimer

1984: prima fase

1999: seconda fase

(i) presence of a subjective memory complaint(ii) preserved general intellectual functioning (iii) demonstration of a memory impairment by cognitive testing(iv) intact ability to perform activities of daily living; (v) absence of dementia.

A biomarker is a characteristic that is objectively measured and

evaluated as an indicator of normal biological processes,

pathogenic processes, or pharmacologic responses to a

therapeutic intervention

NIH, 1998

In the original description of the MCI cohort followed at

the Mayo Clinic, the MCI group's mean performance was

1.5 SD below their age‐mates. However, this was not a cutoff score, and of course, nearly half of the group had

memory performance score falling somewhat

2011

…Research studies have shown that there are a variety of episodic memory tests that are useful for identifyingthose MCI patients who have a high likelihood of progressing to AD dementia within a fewyears…These tests share the characteristic that they assess both immediate and delayed recall,so that it is possible to determine retention over a delay…Examples of such testsinclude (but are not limited to): the Free and Cued Selective Reminding Test, the ReyAuditory Verbal Learning Test, and the California Verbal Learning Test…

If formal cognitive testing is not feasible, then cognitive function can be assessed using avariety of simple, informal techniques…It is important, however, forclinicians to recognize that these informal tests will likely be insensitive to subtle cognitivedysfunction during the early stages of MCI, and will often yield normal performance.

Dubois 1 (2007) Dubois 2 (2010) Dubois 3 (2014)

2018: terza fase (?)

Clinical judgement and/or cognitive test performance

With or without adjustment for age, education, sex, etc.

Progressionto prodromal AD (3 years): 6,6%

Progression to MCI (4 years): 21.1 vs 8.5%

Progression to MCI (7 years): 10%

La cognizione come biomarker

• Subjective (S)

• Objective (O)

S+ 0 + MCI

S+ O- SCC, SCC-plus (Jessen et al, 2014)

S- O+ LCA (Cacciamani et al., 2017)

La prospettiva attuale…

• La valutazione cognitiva/comportamentale/dei sistemi come componente della valutazione del rischio, assieme ad altri fattori(genetici, stili divita, comorbidità)

• La valutazione cognitiva/comportamentale/dei sistemi come indicesensibile di insufficiente compensazione• Sensibilità a minime modificazioni nel tempo

• Specificità per patologia

• Minima richiesta di partecipazione (“valutazione passiva”)

• Validità ecologica

Armonizzazione

Innovazione

1959

In sintesi

• L’evoluzione dei criteri diagnostici modifica il ruolo della valutazionecognitiva, che mantiene un ruolo centrale

• L’armonizzazione di un set di dati minimo è una priorità per gli studi di rete (es. rete IRCCS, progetto Interceptor)

• L’innovazione deve sfruttare gli sviluppi tecnologici e dei metodi di analisi dei dati per affrontare le nuove richieste (studi longitudinali, clinical trials)