Anne-Claude Juillerat

Memory evaluation with a new cued recall test in patients with mild cognitive impairment and Alzheimer’s disease

Free delayed recall is considered the memory measure with the greatest sensitivity for the early diagnosis of dementia. However, its specificity for dementia could be lower, as deficits other than those of pure memory might account for poor performance in this difficult and effortful task. Cued recall is supposed to allow a better distinction between poor memory due to concurrent factors and impairments related to the neurodegenerative process. The available cued recall tests suffer from a ceiling effect. This is a prospective, longitudinal study aiming to assess the utility of a new memory test based on cued recall that avoids the ceiling effect in the early diagnosis of Alzheimer’s disease (AD). Twenty-five patients with mild cognitive impairment (MCI), 22 probable AD patients (NINCDS-ADRDA) at a mild stage, 22 elderly patients with subjective memory complaints (SMC) and 38 normal age-matched controls took part in the study. The patients underwent a thorough cognitive evaluation and the recommended screening procedure for the diagnosis of dementia. All patients were re-examined 12–18 months later. A newly devised delayed cued recall test using semantic cues (The RI48 Test) was compared with three established memory tests: the Ten Word-List Recall from CERAD, the “Doors” and the “Shapes” Tests from “The Doors and People Test Battery”. Forty-four % of the MCI patients fulfilled criteria for probable AD at follow-up. The RI48 Test classified correctly 88% of the MCI and SMC participants and was the best predictor of the status of MCI and mild AD as well as the outcome of the MCI patients. Poor visual memory was the second best predictor of those MCI patients who evolved to AD. A cued recall test which avoids the ceiling effect is at least as good as the delayed free recall tests in the early detection of AD.

A French Adaptation of the UPPS Impulsive Behavior Scale

Impulsivity is an important and multifaceted psychological construct. Recently, Whiteside and Lynam (2001) have developed the UPPS Impulsive Behavior Scale that distinguishes four dimensions of impulsivity: Urgency, lack of Premeditation, lack of Perseverance, and Sensation seeking. In the present study, we investigated the psychometric properties of a French adaptation of the UPPS Impulsive Behavior Scale. Two hundred and thirty-four undergraduate students completed the UPPS Scale. Exploratory and confirmatory analyses revealed a four factors solution similar to that found in the original study. Also, the results indicated that there was good to very good internal reliability for the four subscales.

Dementia Screening and Surveillance Are There Opportunities for Early Detection

The prevalence of dementia, and in particular Alzheimer’s disease, is expected to increase dramatically in the elderly population over the next few decades. Because of the possibilities of pharmacological and psychosocial interventions, which aim to slow down or even prevent progress of the disease, early detection of dementia is of the utmost importance. The screening of patients at risk is the first step in the detection of dementia and should be undertaken at the primary healthcare level. A history and mental state examination is necessary for all patients, and in particular for elderly patients, who have had cognitive complaints and/or reports of cognitive decline. Useful screening tests for dementia are either the Mini-Mental State Examination (MMSE) or the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE); an MMSE score <27 and an IQCODE score >3.31 indicate a possible dementia and should be further investigated. However, neither MMSE nor IQCODE should be used as a diagnostic tool.Because of the heterogeneity of the deficits and the absence of a biological marker, the diagnosis of early degenerative dementias can be very complex and requires a multidisciplinary approach. Basic routine investigations carried out at the general practitioner (GP) level include physical and neurological examinations, a laboratory screen and a computerised tomography or magnetic resonance imaging examination. A neuropsychological examination is necessary to establish the diagnosis and there is promising evidence for the predictive value of some specific tests for Alzheimer’s disease. Complementary investigations such as functional neuroimaging, electroencephalogram and CSF investigations, may be indicated in some cases.Efficient management programmes can only be effective if they are implemented as early as possible and adapted regularly to the changing needs of patients with dementia and their caregivers. The creation of health teams working in the community under the supervision of a GP seems to be a promising model for the care of the patient with dementia living in the community.