INS NYC 2024 Program

Poster	Poster Session 02 Program Schedule 02/15/2024 08:00 am - 09:15 am Room: Shubert Complex (Posters 1-60) Poster Session 02: Aging \| MCI \| Neurodegenerative Disease - PART 1 Final Abstract #15 The Sequencing Sign: A Unique Dementia Phenomenon Hilary Clark, West Virginia University, Morgantown, United States Lee Isaac, University of Arkansas for Medical Sciences, Little Rock, United States Holly Phelps, West Virginia University, Morgantown, United States Liv Miller, West Virginia University, Morgantown, United States Wei Fang, West Virginia Clinical and Translational Science Institute, Morgantown, United States Cierra Keith, West Virginia University, Morgantown, United States Marc Haut, West Virginia University, Morgantown, United States David Scarisbrick, West Virginia University, Morgantown, United States Category: Dementia (Alzheimer's Disease) Keyword 1: dementia - Alzheimer's disease Keyword 2: dementia - other cortical Keyword 3: executive functions Objective: Previous research by Clark et al. (2022) identified an interesting pattern of performance on WAIS-IV Digit Span Sequencing (DSS) exhibited by dementia patients. Patients become confused by the first item already being in order and start reversing the numbers, resulting in a raw score of one. This phenomenon, called the sequencing sign (SS), was found to predict an Alzheimer’s disease (AD) diagnosis. The current study attempted to cross-validate and extend these findings in a larger sample. Participants and Methods: Participants were 60-90 years old and completed outpatient evaluations including WAIS-IV Digit Span and CVLT-II (Standard or Short Form). Patients were excluded if they failed CVLT-II Forced Choice (missed more than 2 items, based on research by Grewal et al., 2022) or received cueing from the psychometrist that affected their DSS performance. The sample consisted of 533 patients (mean age=73, mean education=14 years, 97% White). Eighty-one (15%) showed the SS. Participants were classified as having no cognitive diagnosis (n=48), Mild Neurocognitive Disorder (NCD; n=212), or Major NCD (n=273). The most common Mild NCD etiologies were AD (47%), unknown (19%), vascular (15%), and Parkinson’s (12%). Major NCD etiologies included AD (79%), vascular (8%), frontotemporal (FTD; 6%), Lewy body (LBD; 5%), and mixed AD/vascular (2%). Base rates were calculated to assess the frequency of the SS across diagnoses. Binary logistic regression was used to determine if the SS predicts AD or Major NCD. Sensitivity and specificity were also examined. To understand why the SS occurs, additional binary logistic regression analyses were conducted using working memory (Digit Span Backward [DSB]), memory (CVLT-II percent retained from last learning trial to long delay), executive functioning (Trails B time), and overall impairment (MMSE total) as predictors. Results: The SS never occurred in individuals without a cognitive diagnosis, was seen rarely in Mild NCD (n=8; 4%), and happened often in Major NCD (n=73; 27%). Base rates for Major NCD subtypes were as follows: LBD=46%, mixed AD/vascular=33%, AD=27%, vascular=27%, and FTD=6%. The SS did not predict AD compared to other dementia etiologies, but it predicted Major NCD compared to Mild NCD/no cognitive diagnosis (odds ratio [OR]=11.50; p<.001). Specificity for Major NCD was 97%. Sensitivity was 27%. The SS was predicted by Trails B time (OR=1.01, p<.01) and MMSE total (OR=0.93, p<.05). Neither DSB nor CVLT-II percent retained were statistically significant predictors. Conclusions: The SS occurred frequently across most dementia etiologies. Unlike previous research findings, the SS did not preferentially predict AD. However, it predicted Major NCD in general. Specificity and sensitivity show that the SS is a strong indicator of dementia, although its absence does not exclude dementia. Consequently, the SS can be useful for clinicians considering whether to assign a dementia diagnosis. Regarding why the SS occurs, it does not seem to be caused by problems with working memory or memory. Instead, it appears to be linked to worse overall impairment and executive dysfunction. Future research is warranted to understand the discrepancy between current and past results and further examine the cause of the SS.

Poster

02/15/2024
08:00 am - 09:15 am
Room: Shubert Complex (Posters 1-60)

Poster Session 02: Aging | MCI | Neurodegenerative Disease - PART 1

Final Abstract #15

The Sequencing Sign: A Unique Dementia Phenomenon

Hilary Clark, West Virginia University, Morgantown, United States
Lee Isaac, University of Arkansas for Medical Sciences, Little Rock, United States
Holly Phelps, West Virginia University, Morgantown, United States
Liv Miller, West Virginia University, Morgantown, United States
Wei Fang, West Virginia Clinical and Translational Science Institute, Morgantown, United States
Cierra Keith, West Virginia University, Morgantown, United States
Marc Haut, West Virginia University, Morgantown, United States
David Scarisbrick, West Virginia University, Morgantown, United States

Category: Dementia (Alzheimer's Disease)

Keyword 1: dementia - Alzheimer's disease
Keyword 2: dementia - other cortical
Keyword 3: executive functions

Objective:

Previous research by Clark et al. (2022) identified an interesting pattern of performance on WAIS-IV Digit Span Sequencing (DSS) exhibited by dementia patients. Patients become confused by the first item already being in order and start reversing the numbers, resulting in a raw score of one. This phenomenon, called the sequencing sign (SS), was found to predict an Alzheimer’s disease (AD) diagnosis. The current study attempted to cross-validate and extend these findings in a larger sample.

Participants and Methods:

Participants were 60-90 years old and completed outpatient evaluations including WAIS-IV Digit Span and CVLT-II (Standard or Short Form). Patients were excluded if they failed CVLT-II Forced Choice (missed more than 2 items, based on research by Grewal et al., 2022) or received cueing from the psychometrist that affected their DSS performance. The sample consisted of 533 patients (mean age=73, mean education=14 years, 97% White). Eighty-one (15%) showed the SS. Participants were classified as having no cognitive diagnosis (n=48), Mild Neurocognitive Disorder (NCD; n=212), or Major NCD (n=273). The most common Mild NCD etiologies were AD (47%), unknown (19%), vascular (15%), and Parkinson’s (12%). Major NCD etiologies included AD (79%), vascular (8%), frontotemporal (FTD; 6%), Lewy body (LBD; 5%), and mixed AD/vascular (2%). Base rates were calculated to assess the frequency of the SS across diagnoses. Binary logistic regression was used to determine if the SS predicts AD or Major NCD. Sensitivity and specificity were also examined. To understand why the SS occurs, additional binary logistic regression analyses were conducted using working memory (Digit Span Backward [DSB]), memory (CVLT-II percent retained from last learning trial to long delay), executive functioning (Trails B time), and overall impairment (MMSE total) as predictors.

Results:

The SS never occurred in individuals without a cognitive diagnosis, was seen rarely in Mild NCD (n=8; 4%), and happened often in Major NCD (n=73; 27%). Base rates for Major NCD subtypes were as follows: LBD=46%, mixed AD/vascular=33%, AD=27%, vascular=27%, and FTD=6%. The SS did not predict AD compared to other dementia etiologies, but it predicted Major NCD compared to Mild NCD/no cognitive diagnosis (odds ratio [OR]=11.50; p<.001). Specificity for Major NCD was 97%. Sensitivity was 27%. The SS was predicted by Trails B time (OR=1.01, p<.01) and MMSE total (OR=0.93, p<.05). Neither DSB nor CVLT-II percent retained were statistically significant predictors.

Conclusions:

The SS occurred frequently across most dementia etiologies. Unlike previous research findings, the SS did not preferentially predict AD. However, it predicted Major NCD in general. Specificity and sensitivity show that the SS is a strong indicator of dementia, although its absence does not exclude dementia. Consequently, the SS can be useful for clinicians considering whether to assign a dementia diagnosis. Regarding why the SS occurs, it does not seem to be caused by problems with working memory or memory. Instead, it appears to be linked to worse overall impairment and executive dysfunction. Future research is warranted to understand the discrepancy between current and past results and further examine the cause of the SS.