The emergence of cognitive discrepancies in preclinical Alzheimer's disease: A six-year case study

We present neuropsychological data from an 81-year-old individual who was followed over a six-year period, initially as a healthy control participant. She performed above age-adjusted cutoff scores for impairment on most neuropsychological tests, including learning and memory measures, until the final assessment when she received a diagnosis of probable Alzheimer's disease (AD). Despite generally normal scores on individual cognitive tests, her cognitive profile revealed increasingly large cognitive discrepancies when contrasting verbal versus visuospatial tasks, and complex versus basic-level tasks. The present case provides intriguing evidence that cognitive-discrepancy measures could improve our ability to detect subtle changes in cognition at the earliest, preclinical stages of AD.

[1]  P. Garthwaite,et al.  On the reliability and standard errors of measurement of contrast measures from the D-KEFS , 2008, Journal of the International Neuropsychological Society.

[2]  K. D. de Laat,et al.  Subjective cognitive failures and hippocampal volume in elderly with white matter lesions , 2008, Neurology.

[3]  B. Carretti,et al.  Interplay between memory and executive functions in normal and pathological aging , 2008, Journal of clinical and experimental neuropsychology.

[4]  J. Hodges,et al.  Naming of objects, faces and buildings in mild cognitive impairment , 2008, Cortex.

[5]  G. Schellenberg,et al.  Apolipoprotein E genotype and memory in the sixth decade of life , 2008, Neurology.

[6]  D. Delis,et al.  Neuropsychological Contributions to the Early Identification of Alzheimer’s Disease , 2008, Neuropsychology Review.

[7]  A. Tröster Neuropsychological Characteristics of Dementia with Lewy Bodies and Parkinson’s Disease with Dementia: Differentiation, Early Detection, and Implications for “Mild Cognitive Impairment” and Biomarkers , 2008, Neuropsychology Review.

[8]  Phillip J. Holcomb,et al.  Compensatory neural activity distinguishes different patterns of normal cognitive aging , 2008, NeuroImage.

[9]  Lars Bäckman,et al.  Longitudinal Trajectories of Cognitive Change in Preclinical Alzheimer's Disease: A Growth Mixture Modeling Analysis , 2007, Cortex.

[10]  Justin L. Vincent,et al.  Disruption of Large-Scale Brain Systems in Advanced Aging , 2007, Neuron.

[11]  P. Scheltens,et al.  Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS–ADRDA criteria , 2007, The Lancet Neurology.

[12]  V. Pankratz,et al.  A plateau in pre-Alzheimer memory decline , 2007, Neurology.

[13]  P. Garthwaite,et al.  Estimating the percentage of the population with abnormally low scores (or abnormally large score differences) on standardized neuropsychological test batteries: a generic method with applications. , 2007, Neuropsychology.

[14]  T. Giovannetti,et al.  Environmental adaptations improve everyday action performance in Alzheimer's disease: empirical support from performance-based assessment. , 2007, Neuropsychology.

[15]  D. Steffens,et al.  Contribution of Depression to Cognitive Impairment and Dementia in Older Adults , 2007, The neurologist.

[16]  M. Albert,et al.  Longitudinal change in cognitive performance among individuals with mild cognitive impairment. , 2007, Neuropsychology.

[17]  Patrizia Mecocci,et al.  Mild cognitive impairment: a systematic review. , 2007, Journal of Alzheimer's disease : JAD.

[18]  R. Dean,et al.  TEST REVIEW: Dean C. Delis, Edith Kaplan & Joel H. Kramer, Delis Kaplan Executive Function System (D-KEFS), The Psychological Corporation, San Antonio, TX, 2001. $415.00 (complete kit) , 2006 .

[19]  J. Donders Performance discrepancies on the California Verbal Learning Test--Second Edition (CVLT-II) in the standardization sample. , 2006, Psychological assessment.

[20]  Howard J. Rosen,et al.  Multiple Cognitive Deficits in Amnestic Mild Cognitive Impairment , 2006, Dementia and Geriatric Cognitive Disorders.

[21]  G. Chelune,et al.  Development of WAIS-III General Ability Index Minus WMS-III Memory Discrepancy Scores , 2006, The Clinical neuropsychologist.

[22]  D. Delis,et al.  Heterogeneity in Verbal Memory: A Marker of Preclinical Alzheimer's Disease? , 2006, Neuropsychology, development, and cognition. Section B, Aging, neuropsychology and cognition.

[23]  E. Twamley,et al.  Neuropsychological and neuroimaging changes in preclinical Alzheimer's disease , 2006, Journal of the International Neuropsychological Society.

[24]  J Philip Miller,et al.  Longitudinal course and neuropathologic outcomes in original vs revised MCI and in pre-MCI , 2006, Neurology.

[25]  G. Chelune,et al.  Application of New WAIS-III/WMS-III Discrepancy Scores for Evaluating Memory Functioning: Relationship Between Intellectual and Memory Ability , 2006, Journal of Clinical and Experimental Neuropsychology.

[26]  A. Akaike Preclinical Evidence of Neuroprotection by Cholinesterase Inhibitors , 2006, Alzheimer disease and associated disorders.

[27]  L H Kuller,et al.  Neuropsychological characteristics of mild cognitive impairment subgroups , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[28]  D. Delis,et al.  Asymmetries in global-local processing ability in elderly people with the apolipoprotein E-ε4 allele , 2005 .

[29]  D. Delis,et al.  Deficits in Inhibition and Flexibility are Associated with the APOE-E4 Allele in Nondemented Older Adults , 2005, Journal of clinical and experimental neuropsychology.

[30]  Dean C Delis,et al.  Executive function asymmetry in older adults genetically at-risk for Alzheimer's disease: Verbal versus design fluency , 2005, Journal of the International Neuropsychological Society.

[31]  Paul H Garthwaite,et al.  Testing for suspected impairments and dissociations in single-case studies in neuropsychology: evaluation of alternatives using monte carlo simulations and revised tests for dissociations. , 2005, Neuropsychology.

[32]  I. Grant,et al.  Test-Retest Reliability of Component Process Variables Within the Hopkins Verbal Learning Test-Revised , 2005, Assessment.

[33]  N. Fox,et al.  A decade of pre-diagnostic assessment in a case of familial Alzheimer’s disease: tracking progression from asymptomatic to MCI and dementia , 2005, Neurocase.

[34]  D. Meier,et al.  The Effect of a Social Work Intervention to Enhance Advance Care Planning Documentation in the Nursing Home , 2005, Journal of the American Geriatrics Society.

[35]  D. Delis,et al.  Asymmetry in Auditory and Spatial Attention Span in Normal Elderly Genetically At Risk for Alzheimer’s Disease , 2005, Journal of clinical and experimental neuropsychology.

[36]  L. Bäckman,et al.  Multiple cognitive deficits during the transition to Alzheimer's disease , 2004, Journal of internal medicine.

[37]  R. Petersen Mild cognitive impairment as a diagnostic entity , 2004, Journal of internal medicine.

[38]  G. Chelune,et al.  Education-stratified base-rate information on discrepancy scores within and between the Wechsler Adult Intelligence Scale--Third Edition and the Wechsler Memory Scale--Third Edition. , 2004, Psychological assessment.

[39]  Ronald C Petersen,et al.  Cognitive asymmetries associated with apolipoprotein E genotype in patients with Alzheimer's disease , 2003, Journal of the International Neuropsychological Society.

[40]  H. Tuokko,et al.  Cognitive decline in high-functioning older adults: Reserve or ascertainment bias? , 2003, Aging & mental health.

[41]  J. Buckwalter,et al.  Better preservation of memory span relative to supraspan immediate recall in Alzheimer’s disease , 2002, Neuropsychologia.

[42]  J. Miguel-Hidalgo,et al.  Neuroprotection by memantine against neurodegeneration induced by β-amyloid(1–40) , 2002, Brain Research.

[43]  Erin D Bigler,et al.  Dementia, asymmetry of temporal lobe structures, and Apolipoprotein E genotype: Relationships to cerebral atrophy and neuropsychological impairment , 2002, Journal of the International Neuropsychological Society.

[44]  L. Thal,et al.  Alzheimer’s disease can be accurately diagnosed in very mildly impaired individuals , 2002, Neurology.

[45]  D. Delis,et al.  Do neuropsychological tests detect preclinical Alzheimer's disease: individual-test versus cognitive-discrepancy score analyses. , 2002, Neuropsychology.

[46]  F. Vajda Neuroprotection and neurodegenerative disease , 2002, Journal of Clinical Neuroscience.

[47]  G. Chelune,et al.  WMS–III performance in patients with temporal lobe epilepsy: Group differences and individual classification , 2001, Journal of the International Neuropsychological Society.

[48]  D. Tulsky,et al.  The influence of IQ Stratification on WAIS–III/WMS–III FSIQ–General Memory Index discrepancy base-rates in the standardization sample , 2001, Journal of the International Neuropsychological Society.

[49]  L. Fratiglioni,et al.  Canaries in a coal mine: cognitive markers of preclinical Alzheimer disease. , 2001, Archives of general psychiatry.

[50]  G Ratcliff,et al.  Patterns of cognitive decline in presymptomatic Alzheimer disease: a prospective community study. , 2001, Archives of general psychiatry.

[51]  D. Delis,et al.  Do Subgroups of Patients With Alzheimers Disease Exhibit Asymmetric Deficits on Memory Tests? , 2001, Journal of clinical and experimental neuropsychology.

[52]  J. Price,et al.  Absence of cognitive impairment or decline in preclinical Alzheimer’s disease , 2001, Neurology.

[53]  G. Ratcliff,et al.  Cognitive tests that best discriminate between presymptomatic AD and those who remain nondemented , 2000, Neurology.

[54]  Raja Parasuraman,et al.  Genetics and visual attention: Selective deficits in healthy adult carriers of the ɛ4 allele of the apolipoprotein E gene , 2000 .

[55]  J. Kaye,et al.  Longitudinal Analysis of the Effects of the Aging Process on Neuropsychological Test Performance in the Healthy Young-Old and Oldest-Old , 2000, Developmental neuropsychology.

[56]  E. Tangalos,et al.  Diagnostic accuracy of four approaches to interpreting neuropsychological test data. , 2000, Neuropsychology.

[57]  E. Tangalos,et al.  Testing normal older people three or four times at 1- to 2-year intervals: defining normal variance. , 1999, Neuropsychology.

[58]  B. Axelrod,et al.  Effects of Practice in Repeated Administrations of the Wechsler Memory Scale-Revised in Normal Adults , 1998, Assessment.

[59]  R. Doody,et al.  Neuropsychological asymmetry in Alzheimer's disease: Verbal versus visuoconstructional deficits across stages of dementia , 1997, Journal of the International Neuropsychological Society.

[60]  A. Paolo,et al.  California Verbal Learning Test: normative data for the elderly. , 1997, Journal of clinical and experimental neuropsychology.

[61]  F. Le Doze,et al.  Drugs used in Alzheimer's disease and neuroplasticity. , 1997, Clinical therapeutics.

[62]  R. Doody,et al.  Hemispheric asymmetry in Alzheimer's disease is apparent in motor functioning. , 1996, Journal of clinical and experimental neuropsychology.

[63]  F Fazio,et al.  Correlations between cognitive impairment, middle cerebral artery flow velocity and cortical glucose metabolism in the early phase of Alzheimer's disease. , 1995, Dementia.

[64]  Raja Parasuraman,et al.  Cognition in Alzheimer's disease: disorders of attention and semantic knowledge , 1994, Current Opinion in Neurobiology.

[65]  H. Soininen,et al.  Volumetric MRI analysis of the amygdala and the hippocampus in subjects with age‐associated memory impairment , 1994, Neurology.

[66]  J. Haines,et al.  Gene dose of apolipoprotein E type 4 allele and the risk of Alzheimer's disease in late onset families. , 1993, Science.

[67]  D. Delis,et al.  Spatial cognition in Alzheimer's disease: subtypes of global-local impairment. , 1992, Journal of clinical and experimental neuropsychology.

[68]  P. Satz,et al.  Effect of repeated administration of a neuropsychological battery in the elderly. , 1991, Journal of clinical psychology.

[69]  F. Duffy,et al.  Electrophysiologic comparisons between two groups of patients with Alzheimer's disease. , 1990, Archives of neurology.

[70]  J. Haxby,et al.  Longitudinal study of cerebral metabolic asymmetries and associated neuropsychological patterns in early dementia of the Alzheimer type. , 1990, Archives of neurology.

[71]  D. Grossi,et al.  Immediate Memory Spans in Dementia , 1988, Perceptual and motor skills.

[72]  E. Kaplan,et al.  The Boston naming test , 2001 .

[73]  Elbert W. Russell,et al.  A multiple scoring method for the assessment of complex memory functions. , 1975 .