dwg trueview 32 bit free download more accurately assessed with tests that overcome this limitation by controlling for attentional and executive processes.">
Genuine memory deficits in dementia. Dev Neuropsychol. National Center for Biotechnology Information , U. Alzheimer Dis Assoc Disord. Author manuscript; available in PMC Jul 1. Ellen Grober , PhD. Sanders , M. Lipton , M. Author information Copyright and License information Disclaimer. Corresponding Author: Ellen Grober, Ph. Copyright notice. The publisher's final edited version of this article is available at Alzheimer Dis Assoc Disord.
See other articles in PMC that cite the published article. Abstract The Free and Cued Selective Reminding Test FCSRT is used widely to identify very mild dementia; three alternative scoring procedures have been proposed based on free recall, total recall, and cue efficiency. Introduction Memory testing is critical to identifying dementia because current criteria for the diagnosis of any dementia, irrespective of subtype, requires memory impairment.
Table 1 Diagnostic Battery. Open in a separate window. Diagnostic procedures At baseline and at each subsequent cross-sectional evaluation, a consensus panel consisting of a neuropsychologist EG , a geriatrician, and a geriatric psychiatrist used results of the independent diagnostic battery of neuropsychological tests and the informant interviews to determine presence or absence of dementia according to DSM IV criteria for dementia.
Statistical procedures Baseline scores on free recall, total recall, and cue efficiency from the prospective cohort were the main predictors. Table 2 Characteristics of study participants at baseline.. Figure 1. Table 3 Logistic regression models for predicting prevalent dementia using free recall 3A , total recall 3B , both free and total recall 3C. Odds ratio Lower.
Figure 2. Table 5 Cox Proportional Hazards Models for predicting incident dementia using free recall 5A , total recall 5B , free and total recall 5C.
Exp coef Lower. Discussion We compared three scores derived from the FCSRT the free recall, total recall and cue efficiency in their ability to identify prevalent dementia, predict future incident dementia and distinguish AD and nonAD dementias in a primary care setting.
Footnotes This is a PDF file of an unedited manuscript that has been accepted for publication. References 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Alzheimer's Disease and Associated Disorders, Supplement. In an epidemiological sample the apolipoprotein E4 allele is associated to dementia and loss of memory function only in the very old. Neuroscience Letters. Screening for dementia by memory testing. Memory function in very early Alzheimer's disease.
Alzheimer Disease and Associated Disorders. Tuokko H, Crockett D. Cued recall and memory disorders in dementia. Journal of Clinical and Experimental Neuropsychology. Memory impairment on free and cued selective reminding predicts dementia.
Grober E, Kawas C. Learning and retention in preclinical and early Alzheimer's Disease. Psychology and Aging. Apolipoprotein E status as a predictor of the development of Alzheimer's disease in memory-impaired individuals.
Neuropsychological performance in mild cognitive impairment with and without apathy. Dementia and Geriatric Cognitive Disorders.
Journal of the International Neuropsychological Association. Amnestic syndrome of the medial temporal type identifies prodromal AD: A longitudinal study. Patterns of memory impairment and perseverative behavior discriminate early Alzheimer's disease from subcortical vascular dementia. Journal of the Neurological Sciences. Explicit memory in Alzheimer's, Huntington's, and Parkinson's diseases. Arch Neurol. Free and Cued Selective Reminding distinguishes Alzherimer's disease from vascular dementia.
Journal of the American Geriatrics Society. Buschke H. Cued recall in Amnesia. Grober E, Buschke H. Genuine memory deficits in dementia. Developmental Neuropsychology. Comparison of selective reminding and free and cued selective reminding in the elderly.
J Clinical and Experimental Neuropsychology. Aging, encoding specificity, and memory change in the Double Memory Test. Neuropsychological strategies for detecting early dementia. Journal of the International Neuropsychological Society. One way of controlling the acquisition and retrieval of information is to use the same cues to direct learning and produce effective cued recall. Furthermore, memory tests that require the ability to control acquisition and retrieval may optimize encoding specificity and thus may be more sensitive to the early signs of dementia Buschke, than tests that use different paradigms.
The Free and Cued Selective Reminding Test FCSRT; Buschke, is a memory test that controls attention and cognitive processing, requiring subjects to search for items in response to their category cues, in the learning process. Moreover, these same category cues are given later to participants in order to elicit the recall of the items not retrieved on the free recall trial, thus controlling acquisition and retrieval.
A poor performance on the FCSRT has also shown a high correlation with atrophy in the medial temporal lobe Habert et al. The cognitive deficits of bv-FTD include impairments on executive function, attention, working memory, poor abstraction and difficulty in shifting mental set leading to perseverative tendencies Neary et al. It is also usually associated with bilateral symmetrical frontal and anterior temporal atrophy Neary et al.
Research has shown that the specific pattern of impairment of bv-FTD includes a relative sparing of memory and visuospatial functions in comparison to executive functions which are most commonly affected Rascovsky et al. In order to distinguish between these cognitive profiles, memory may be more accurately assessed with tests that overcome this limitation by controlling for attentional and executive processes.
Additionally, we aimed to characterize the memory impairment in patients with bv-FTD in comparison to AD patients. Our hypothesis was that the proposed cognitive mechanisms underlying these memory deficits would differentiate the two pathologies. This would be revealed as bv-FTD patients may benefit more from the controlled learning conditions which involves category cueing, than AD patients.
The total sample included 96 subjects divided into three subgroups: i 32 bv-FTD patients, ii 32 AD patients, and iii 32 cognitively healthy adults.
The clinical study sample was recruited at the Neurology Department of the Coimbra University Hospital. The bv-FTD group included only patients with a diagnosis of the behavioral variant of FTD, established by a multidisciplinary team according to international criteria Neary et al. This group was recruited to match the patients with bv-FTD by gender, age, education level, and severity of cognitive decline mild forms , as assessed by the Clinical Dementia Rating scale CDR; Garrett et al.
The control group comprised 32 cognitively healthy adults belonging to the local community recruited among the patients' spouses, hospital or university staff, or their relatives that was age, education, and gender matched to the patients.
They had no history of neurological or psychiatric relevant condition, including alcohol or drugs abuse or head trauma, and no significant motor, visual or auditory deficits which could influence the neuropsychological performance. All control subjects had normal MMSE scores mean The study was conducted in accordance with the tenets of the Declaration of Helsinki, with the approval of our local ethics committee. After obtaining an Informed consent, all the participants were submitted to the same experimental research protocol.
Demographical and clinical characteristics of the population. Copyright, The test starts by asking subjects to identify words or pictures in response to a unique category cue. The 16 items to be learned are presented four at a time on a card, distributed by one word per quadrant.
The subject is asked to search each card and point to and name aloud each item after its semantic cue was aurally presented. During this procedure, the subject is informed to learn the 16 words.
There are three recall trials, each preceded by 20 s of counting backward to prevent recall from short-term memory. Each recall trial consisted of two parts. First, each subject had up to 2 min to freely recall as many items as possible. Next, aurally presented category cues were provided for items not retrieved by free immediate recall Free IR.
If subjects failed to retrieve the item with the category cue, they were reminded by presenting the cue and the item together Cued IR.
The sum of free and cued recall gives a measure of total immediate recall Total IR. A percentage of retention was also computed, by comparing the total number of items recalled freely and on delayed recall to the total of items free and cued recalled on the third learning trial.
When data significantly deviated from normal distributions verified using the Shapiro—Wilk normality check and Levene homogeneity tests we did therefore choose to apply non-parametric statistical methods. Descriptive statistics were used for sample's characterization; comparisons between means were performed with the use of the general linear model [one-way analysis of variance ANOVA ] with post hoc Tukey for multiple comparisons or the Kruskal—Wallis one-way ANOVA for k samples with pairwise comparisons with adjusted p -value.
Cronbach's alpha reliability coefficient was considered as an index of internal consistency, and analyzed separately for the immediate and delayed recalls. Non-parametric Wilcoxon test was used to compare the performance between the learning trials among each group. A logistic regression model was fit to the data with impairment on both total immediate and total delayed recalls of the FCSRT as the outcome, and dementia subtype was a significant predictor in order to determine the sensitivity and the specificity of the FCSRT measures for distinguishing AD from bv-FTD.
Concerning the performance on the preliminary neuropsychological tests, main effects were found in all of them, except for the Forward Digit Span. Performance on the preliminary tests. The model showed an accuracy of Furthermore, we aimed to contribute to the characterization of the memory impairment observed in patients with bv-FTD in comparison with AD patients.
The FCSRT showed an overall good reliability with high indexes of internal consistency for the immediate recall and for the delayed recall trials, in this sample of Portuguese participants. We observed that both groups were relatively impaired to the control group on the free and total immediate and delayed recalls trials. Furthermore, only the AD group showed impairment on the cued recall trial and on the percentage of items retained. Our initial hypothesis was that the mechanisms underlying the memory deficits observed in these groups would differentiate the two pathologies, as bv-FTD patients may benefit more from the controlled learning with the use of category cues, than AD patients.
Our results confirmed that, although bv-FTD patients were impaired on the total recall trials, cueing was more efficient for patients with bv-FTD than AD.
In addition, bv-FTD patients showed an impaired delayed recall but their ability to retain information was spared, that is, when delayed recall performance was compared with performance on the third learning trial. The slopes of the groups' performances were compared on free recall of the three learning trials. Our results showed that the control group performance improved incrementally over the three trials while both the clinical groups' improvement was restricted to just the second and third trials.
The impact of cueing resulted, overall in a significant improvement over the three trials for both the bv-FTD and control groups. However, this effect was only observed between the second and third trials in the AD group. These results showed a pattern of impairment for the AD group independently of the recall free or total ; whereas the bv-FTD group appeared to benefit from cueing which was reflected in a marked improvement in the performance on the total recall trial.
The concept of cueing, inherent in the design of the FCSRT, requires subjects to search for items in response to already given category cues in the learning process, controlling for both attention and cognitive processing. It has been reported that learning and memory ability are based on the integrity of the temporal and frontal lobe regions of the brain.
These are regions which may play different roles depending on the task demands and test characteristics. Much evidence suggests that basic learning and retrieval aspects of memory are supported by the medial temporal lobe. Specifically, it is well documented that the hippocampus plays a significant role in the formation and memorization of associations between novel non-related items Squire, The FCSRT is a memory test that controls for attention and executive processing, by introducing category cues during the learning process.
Additionally, the same cues are used to elicit recall of the items not retrieved on the free recall trial, and thereby control acquisition and retrieval. Our study demonstrated memory impairment in patients within the early stages of bv-FTD. This is common in the early stages of the disease, sometimes leading to a misdiagnosis of AD Wittenberg et al.
Providing a semantic cue to bv-FTD patients showed a significant increase in recall performance, suggesting that there may be impairment in retrieval processes when encoding processes are controlled for. The rates of forgetting did not differ between bv-FTD patients and control subjects, which was assessed by comparing the retention percentages of the two groups, indicating that the bv-FTD group had a relatively intact storage processes.
In sum, poor free and total recall performance rates, both in learning and after a delay, were observed in both dementia groups; low scores in cued recalls and a lower rate of retention were representative of AD, while an improvement with category cueing and spared retained items were suggestive of bv-FTD.
The design characteristics of memory test paradigms may account for the distinct pattern of performance of patients with different types of dementia. Therefore, while AD patients are expected to be impaired on both paradigms, bv-FTD patients are more likely to have deficits on regular word list tests than tests which require the participant to organize semantic information Pasquier et al. Concerning the performance on the neuropsychological tests that measure other cognitive functions, the bv-FTD group showed impairment on attention, working memory, and spontaneous production of words, and spared visuospatial ability and retention.
These findings are congruent with the brain structures reported to be implicated in these abilities and often compromised in this disease.
Nevertheless, executive measures that rely on both frontal compromised in bv-FTD and parietal compromised in AD regions comprise a similar pattern of performance in both disease groups.
Thus, frontally specific executive measures are expected to inform the diagnosis of bv-FTD and therefore should be selected Possin et al. Moreover, in our study, the main pattern of dissociation between bv-FTD and AD was the impairment of parieto-occipital-related functions which seems to be exclusive to AD. Given that FTD is the second cause of primary degenerative dementia and has overlapping symptoms with AD, a misdiagnosis can occur.
For these reasons, it is more informative to use memory tests that control for the learning deficit often observed in FTD patients so as to elicit the retrieval of stored information. This may aid to isolate the memory deficit more typical in AD patients and thereby increase the accuracy of a diagnosis.
However, future research would benefit by including other types of dementias in order to confirm the accuracy values of the FCSRT in informing a diagnosis for AD.
Google Preview. Barreto J. Leuschner A. Santos F. Sobral M. Garcia C. Guerreiro M. Benedict R. Blumenfeld R. Ranganath C. Prefrontal cortex and long-term memory encoding: An integrative review of findings from neuropsychology and neuroimaging Neuroscientist 13 Google Scholar.
Brown L. Storandt M. Sensitivity of category cued recall to very mild dementia of the Alzheimer type Archives of Clinical Neuropsychology 15 Buschke H. Cued recall in amnesia Journal of Clinical and Experimental Neuropsychology 6 Gorfein D.
Hoffman R. Criteria for the identification of memory deficits: Implications for the design of memory tests Memory and learning: The ebbinghaus centenial conference Hillsdale, NJ Lawrence Erlbaum Sliwinski M. Kuslansky G. Lipton R. Diagnosis of early dementia by the Double Memory Test: Encoding specificity improves diagnostic sensitivity and specificity Neurology 48 Cummings J.
Mega M. Gray K. Rosenberg-Thompson S. Carusi D. The protective effects of executive functions and episodic memory on gait speed decline in aging defined in the context of cognitive reserve.
Tracking cognitive change over 24 weeks with longitudinal functional magnetic resonance imaging in Alzheimer's disease. Validity of the five-word test for the evaluation of verbal episodic memory and dementia in a memory clinic setting. Brain perfusion SPECT with an automated quantitative tool can identify prodromal Alzheimer's disease among patients with mild cognitive impairment.
Can maintaining cognitive function at 65 years old predict successful ageing 6 years later? Endogenous estradiol is associated with verbal memory in nondemented older men. Association of a functional polymorphism in the cholesteryl ester transfer protein CETP gene with memory decline and incidence of dementia. Free and cued selective reminding identifies very mild dementia in primary care. The amnestic syndrome of hippocampal type in Alzheimer's disease: an MRI study.