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Texas Health Dallas Researchers Investigate Better Ways to Diagnose Alzheimer’s, Other Forms of Dementia
03/12/2010

DALLAS — Researchers at Texas Health Presbyterian Hospital Dallas and the University of Texas at Tyler say they’ve identified a more precise way to use a common test for Alzheimer’s disease and other forms of dementia. Their findings could eventually help neuropsychologists diagnose Alzheimer’s earlier and better differentiate between different forms of dementia.

Dr. James Harris (left), Dr. Don Hafer (center), and Dr. Eric Smernoff
Dr. James Harris (left), Dr. Don Hafer (center), and Dr. Eric Smernoff
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Their findings, “Factor analysis of the RBANS in a large sample,” appear in the March issue of the journal Applied Neuropsychology. It is the largest study of its kind to-date, analyzing the common RBANS cognitive test in patients with different stages of dementia.

“We’re constantly looking for better ways to identify Alzheimer’s disease and other forms of dementia, so that we can spot it sooner and treat it earlier in the disease cycle,” said Dr. James Harris, a clinical neuropsychologist on the medical staff at Texas Health Dallas and co-author on the paper. “That’s a key to helping patients better deal with the devastating effects of this disease.”

For about 15 years, the RBANS test (Repeatable Battery for the Assessment of Neuropsychological Status) has helped neuropsychologists diagnose patients with dementia, determine the stage of the disease, and even differentiate between different types of dementia and cognitive impairment.

“For years, the RBANS test has been a wonderful tool for neuropsychologists and their dementia patients,” said co-author Dr. Eric Smernoff, a clinical neuropsychologist on the medical staff at Texas Health Dallas. “We’re simply investigating whether there’s a way to hone it into an even more precise tool.”

The RBANS test measures immediate and delayed memory, attention, language, and visual-spatial skills. It’s a written and oral test that measures a person’s cognitive ability, searching for hallmarks of cognitive impairment. The test is administered to patients who have symptoms of dementia or have had a stroke or other event that may impact their cognitive function.

The test is designed to identify which regions of the brain aren’t working properly. Alzheimer’s and other forms of dementia can affect several areas of the brain, whether it’s the temporal or frontal lobes of the brain, where long-term memory and other functions in learning and memory are executed. Patients with recall problems may see a set of car keys but not remember what they’re used for. Another patient might remember a cookie recipe, a type of recall know as semantic memory, but as is common in Alzheimer’s, forget her grandchild’s name or not recognize her spouse.

“Alzheimer’s disease is as seemingly complex as the brain itself,” said researcher Dr. Don Hafer, a clinical neuropsychologist on the medical staff at Texas Health Dallas.

Results from a five-part RBANS test are weighted and analyzed, providing a snapshot of important brain functions. While the test is widely considered a strong tool for dementia diagnosis, only a few thorough analyses of the five RBANS factors have been done until recently. Although the Texas Health Dallas study is not the first factor analysis conducted on the RBANS, it is the largest factor analysis on the RBANS using a clinically impaired sample.

“We think we’ve found a more diagnostically sensitive way to analyze the results of this common dementia test,” said lead author Dr. Andrew Schmitt, a clinical neuropsychologist at the University of Texas at Tyler. “Other studies have made similar observations, but we wanted to examine the subtle differences in the five factors and what the results really mean.”

“Science advances over time,” Schmitt added, “and researchers begin to observe some consensus in the data across different studies.”

Schmitt said that two factors, memory and visuospatial, of the five-part test capture the necessary clinical information to help physicians understand their patients’ brain function.

“That’s an important discovery for the thousands of physicians out there using this test to diagnose patients,” he said. “A more refined cognitive test could help physicians identify people at risk of developing mild cognitive impairment, a transitional and moderate stage of memory loss that sometimes progresses to Alzheimer’s disease. That’s when we might be able to intervene and provide meaningful treatments.”

The study sample was collected by a review of patients evaluated for dementia at Texas Health Dallas between 2002 and 2008. The project looked at the tests of 636 patients, ranging in age from 42 to 93 years of age.

Other researchers involved in the study include Dr. Ronald Livingston, a psychologist at UT Tyler, and Eirah Reese, a graduate student at UT Tyler.

About Texas Health Presbyterian Hospital Dallas
Texas Health Presbyterian Hospital Dallas is an 866-bed acute care hospital and recognized clinical program leader, having provided compassionate care to the residents of Dallas and surrounding communities since 1966. U.S. News and World Report has ranked Texas Health Dallas among the nation’s best hospitals in digestive disorders, orthopedics, and neurology and neurosurgery. An affiliate of the faith-based, nonprofit Texas Health Resources system, Texas Health Dallas has approximately 4,000 employees and an active medical staff of more than 1,000 physicians. For more information, call 1-877-THR-WELL, or visit TexasHealth.org/Dallas.

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