International Psychogeriatrics

Research Article

Progression of Alzheimer's disease during a three-year follow-up using the CERAD-NB total score: Kuopio ALSOVA study

Ilona Hallikainena1, Tuomo Hänninena2, Mikael Fraunberga3, Kristiina Hongistoa1, Tarja Välimäkia4a5, Asta Hiltunena6, Pertti Karppia7, Juhani Siveniusa1a8, Hilkka Soininena1a2 and Anne M. Koivistoa1a2 c1 for the ALSOVA study group

a1 School of Medicine, Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland

a2 Neurology of Neuro Center, Kuopio University Hospital, Kuopio, Finland

a3 Neurosurgery of Neuro Center, Kuopio University Hospital, Kuopio, Finland

a4 Finnish Doctoral Program in Nursing Science, University of Eastern Finland, Kuopio, Finland

a5 Department of Nursing Science, University of Eastern Finland, Kuopio, Finland

a6 Department of Neurology, North Karelia Central Hospital, Joensuu, Finland

a7 Mikkeli Central Hospital, Mikkeli, Finland

a8 Brain Research and Rehabilitation Center Neuron, Kuopio, Finland


Background: We studied the suitability of The Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Battery (CERAD-NB) total score for monitoring Alzheimer's disease (AD) progression in early-diagnosed medicated patients. We also investigated possible differences in progression between patients with very mild or mild baseline AD.

Methods: In this three-year follow-up of 115 ALSOVA study patients with clinical dementia ratings (CDR) of very mild (0.5) or mild (1) AD, we analyzed total CERAD-NB, Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), The Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory, and Clinical Dementia Rating Sum of Boxes scores. Correlations were identified with efficacy parameters.

Results: Over three years, total CERAD-NB declined significantly in both groups. Annual change rates of total CERAD-NB were also significant. Total CERAD-NB revealed annual differences in cognition between study groups, while MMSE did not. Total CERAD-NB correlated well with other cognitive and global measures, but not with NPI. For almost two years, the CDR-0.5 group maintained a higher activities of daily living than the CDR-1 group exhibited at baseline. Furthermore, the CDR-0.5 group showed milder neuropsychiatric symptoms at the end of follow-up than the CDR-1 group showed at baseline.

Conclusions: The CERAD total score is a suitable and sensitive follow-up tool in longitudinal AD trials. Cognition progression rates did not significantly differ between study groups; however, patients with very mild AD at baseline had milder neuropsychiatric symptoms after long-term follow-up. This emphasizes the importance of early diagnosis and assessment of neuropsychiatric symptoms at the diagnostic visit and during follow-up.

(Received November 19 2012)

(Reviewed January 18 2013)

(Revised April 08 2013)

(Accepted April 10 2013)

(Online publication May 16 2013)

Key words:

  • Alzheimer's disease;
  • dementia;
  • CERAD;
  • activities of daily living;
  • neuropsychiatric symptoms;
  • progression


c1 Correspondence should be addressed to: Anne Maria Koivisto, MD, PhD, Neurology of Neuro Center, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland. Phone: +358-40-738 9049, +358-44-717 5629; Fax: +358-17-172305. Email: