Cognitive profiles in dementia: Alzheimer disease vs healthy brain aging.

OBJECTIVE: To re-examine proposed models of cognitive test performance that concluded separate factor structures were required for people with Alzheimer disease (AD) and older adults without dementia. METHODS: Five models of cognitive test performance were compared using multistep confirmatory factor analysis in 115 individuals with autopsy-confirmed AD and 191 research participants without clinical dementia from longitudinal studies at the Washington University AD Research Center. The models were then cross-validated using independent samples of 323 people with clinically diagnosed dementia of the Alzheimer type and 212 cognitively healthy older adults. RESULTS: After controlling for Alzheimer-specific changes in episodic memory, performance on the battery of tests used here was best represented in people both with and without dementia by a single model of one general factor and three specific factors (verbal memory, visuospatial ability, and working memory). Performance by people with dementia was lower on the general factor than it was by those without dementia. Larger variances associated with the specific factors in the group with dementia indicated greater individual differences in the pattern of cognitive deficits in the stage of AD. CONCLUSIONS: A hybrid model of general and specific cognitive domains simplifies cognitive research by allowing direct comparison of normal aging and Alzheimer disease performance. The presence of a general factor maximizes detection of the dementia, whereas the specific factors reveal the heterogeneity of dementia's associated cognitive deficits.

The AD8: a brief informant interview to detect dementia.

BACKGROUND: Brief measures that accurately discriminate normal cognitive aging from very mild dementia are lacking. Cognitive tests often are insensitive to very mild dementia. Informant-based measures may be more sensitive in detecting early dementia. OBJECTIVE: To identify informant-reported clinical variables that differentiate cognitively normal individuals from those with very mild dementia. METHODS: A 55-item battery of informant queries regarding an individual's cognitive status was derived from a semistructured interview and a consensus panel of dementia experts. The battery was evaluated with informants for 189 consecutive participants of a longitudinal study of memory and aging and compared with an independently obtained Clinical Dementia Rating (CDR) score for the participant. Multiple regression and receiver operator characteristic curves assessed subsets of the items to discriminate between CDR 0 (no dementia) and CDR 0.5 (very mild dementia). RESULTS: The final version (AD8) querying memory, orientation, judgment, and function was administered to an additional sample of 112 CDR 0 and 68 CDR 0.5 participants. Using a cut-off of two items endorsed, the area under the curve was 0.834, suggesting good to excellent discrimination, sensitivity was 74%, and specificity was 86% (prevalence of 0.38 for very mild dementia). Inclusion of 56 additional individuals with mild to severe dementia (increasing dementia prevalence to 0.53) increased sensitivity to 85%. CONCLUSIONS: The AD8 is a brief, sensitive measure that reliably differentiates between nondemented and demented individuals. Use of the AD8 in conjunction with a brief assessment of the participant could improve diagnostic accuracy in general practice.

Progressive posterior cortical dysfunction: a clinicopathologic series.

BACKGROUND: Atypical presentations of neurodegenerative dementing disorders include the syndrome of progressive posterior cortical dysfunction (PPCD) involving selective higher order visuospatial deficits. The neuropathologic correlates of PPCD remain poorly defined. METHODS: This is a retrospective case series of 27 individuals (14 men, 13 women) diagnosed clinically with PPCD. Participants were either enrolled in the Alzheimer's Disease Research Center (ADRC) or referred to the memory diagnostic center of an urban academic medical center. Clinical evaluations included physical and neurologic examinations, the Clinical Dementia Rating (CDR), and psychometric measures. Neuropathologic examinations were completed in 21 individuals with PPCD. Psychometric measures from 65 individuals with mild dementia of the Alzheimer type (DAT) enrolled in the ADRC were used for comparison. RESULTS: Neuropathologic etiologies of PPCD were Alzheimer disease (AD) (n = 13), AD plus Parkinson disease (n = 1), AD-Lewy body variant (n = 2), dementia with Lewy bodies plus progressive subcortical gliosis of Neumann (n = 1), corticobasal degeneration (n = 2), and prion-associated diseases: Creutzfeldt-Jakob disease (n = 1) and fatal familial insomnia (n = 1). Confirming the clinical impression, psychometric profiles for individuals with PPCD differed from those of people with DAT alone and revealed disproportionate deficits on measures of visuospatial ability. CONCLUSIONS: AD was the most frequent cause of PPCD in this series, although non-Alzheimer's dementing disorders also should be considered.

Clinically significant depressive symptoms and very mild to mild dementia of the Alzheimer type.

OBJECTIVE: To compare depressive symptoms reported by persons with very mild or mild dementia of the Alzheimer type (DAT) with those reported for the person by a collateral source. DESIGN: Cross-sectional evaluation. SETTING: Washington University Alzheimer's Disease Research Center. PARTICIPANTS: Consecutive series of elderly volunteers (n = 156) enrolled in longitudinal studies with a Clinical Dementia Rating (CDR) of 0.5 (very mild) or 1 (mild). Twenty-one per cent (n = 33) exhibited clinically significant depressive symptoms for which treatment was recommended. MAIN OUTCOME MEASURES: Presence and frequency of DSM-IV depressive symptoms within the last year and last month reported by the participant or collateral source as ascertained by clinical examination and structured interviews. RESULTS: Collateral source information is essential in diagnosing clinically significant depressive symptoms. The Geriatric Depression Scale scores correlate with participant information only and therefore may substantially underestimate depression. Depressive symptoms fluctuate in individuals with DAT. The most consistent depressive symptoms are depressed mood, fatigue and indecision. CONCLUSIONS: Clinically significant depressive symptoms may be common in individuals with very mild or mild DAT, although they may fluctuate. Information from both a knowledgeable collateral source and the participant is important for detection of depressive symptoms.

Mild cognitive impairment represents early-stage Alzheimer disease.

BACKGROUND: Mild cognitive impairment (MCI) is considered to be a transitional stage between aging and Alzheimer disease (AD). OBJECTIVE: To determine whether MCI represents early-stage AD by examining its natural history and neuropathologic basis. DESIGN: A prospective clinical and psychometric study of community-living elderly volunteers, both nondemented and minimally cognitively impaired, followed up for up to 9.5 years. Neuropathologic examinations were performed on participants who had undergone autopsy. SETTING: An AD research center. PARTICIPANTS: All participants enrolled between July 1990 and June 1997 with Clinical Dementia Rating (CDR) scores of 0 (cognitively healthy; n = 177; mean age, 78.9 years) or 0.5 (equivalent to MCI; n = 277; mean age, 76.9 years). Based on the degree of clinical confidence that MCI represented dementia of the Alzheimer type (DAT), 3 subgroups of individuals with CDR scores of 0.5 were identified: CDR 0.5/DAT, CDR 0.5/incipient DAT, and CDR 0.5/uncertain dementia. MAIN OUTCOME MEASURE: Progression to the stage of CDR 1, which characterizes mild definite DAT. RESULTS: Survival analysis showed that 100% of CDR 0.5/DAT participants progressed to greater dementia severity over a 9.5-year period. At 5 years, rates of progression to a score of CDR 1 (or greater) for DAT were 60.5% (95% confidence interval [CI], 50.2%-70.8%) for the CDR 0.5/DAT group, 35.7% (95% CI, 21.0%-50.3%) for the CDR 0.5/incipient DAT group, 19.9% (95% CI, 8.0%-31.8%) for the CDR 0.5/uncertain dementia group, and 6.8% (95% CI, 2.2%-11.3%) for CDR 0/controls. Progression to greater dementia severity correlated with degree of cognitive impairment at baseline. Twenty-four of the 25 participants with scores of CDR 0.5 had a neuropathologic dementing disorder, which was AD in 21 (84%). CONCLUSIONS: Individuals currently characterized as having MCI progress steadily to greater stages of dementia severity at rates dependent on the level of cognitive impairment at entry and they almost always have the neuropathologic features of AD. We conclude that MCI generally represents early-stage AD.

Absence of cognitive impairment or decline in preclinical Alzheimer's disease.

OBJECTIVE: To determine whether clinically nondemented elderly individuals with pathologically confirmed preclinical AD are characterized by cognitive decline as measured by psychometric tests before death. METHODS: Psychometric performance was examined retrospectively in 14 individuals who were nondemented at time of death and grouped in accordance with their neuropathologic findings: 1) Healthy brain (n = 9) was characterized by the absence of senile plaques or by only patchy neocortical deposits of plaques; 2) preclinical AD (n = 5) was characterized by neuritic and diffuse plaques distributed throughout the neocortex. All individuals showed neurofibrillary pathologic change in medial temporal lobe structures. For comparison, we also evaluated 10 individuals who died in the earliest symptomatic stage of dementia of the Alzheimer type (DAT). All individuals had been assessed by clinical and psychometric measures during life. The psychometric measures yielded a standardized factor score that represented global cognitive performance. RESULTS: At the last assessment before death, individuals with very mild DAT were impaired on the factor score and on individual psychometric measures with respect to the nondemented individuals. Those nondemented individuals with preclinical AD did not differ in performance from those with healthy brains. For individuals with at least three psychometric assessments during life, there was no decline in performance for either those with healthy brains (n = 5) or preclinical AD (n = 3), although decline was evident for very mild DAT individuals (n = 5). CONCLUSIONS: Pathologically confirmed preclinical AD is not associated with cognitive impairment or decline, even on measures shown to be sensitive to very mild DAT.

Sensitivity of category cued recall to very mild dementia of the Alzheimer type.

We sought to replicate Buschke, Sliwinski, Kulansky, and Lipton's (1997) finding that the Category Cued Recall portion of the Double Memory Test can discriminate individuals with mild dementia of the Alzheimer type (DAT) and healthy older controls. We then attempted to extend this finding to those with very mild DAT. Finally, we compared these results with those of other tests that discriminate DAT from normal aging. Although we replicated Buschke et al.'s finding that the Category Cued Recall portion of the Double Memory Test discriminates effectively between mildly demented people and controls, it was little more effective in detecting very mild DAT than the WMS Logical Memory subtest nor did it add substantially to the discriminative ability of a brief battery of psychometric tests identified previously.

Age equivalence in feeling-of-knowing experiences.

Three studies investigated potential age-related differences in the reliance of healthy young and older adults on trace-access and inferential mechanisms in making feeling-of-knowing (FOK) judgments. In Experiment 1 young and older adults attempted to retrieve referents of rare-word definitions presented in a self-paced questionnaire. Recall failures were followed by FOK ratings and a report of partial knowledge of referent characteristics. Gamma coefficients revealed age equivalence in FOK accuracy, and the number of recall attempts and FOK ratings did not vary by age. Older adults reported fewer partial characteristics and made more commission errors, which suggests reliance on inferential mechanisms in addition to direct recall of target information. Experiments 2 and 3 examined age-related differences in reliance on trace-access or inferential processes via the influence of type of information primed prior to speeded recall attempt. Contrary to hypothesis, the influence of prime type did not vary by age. Reliance on trace-access and inferential mechanisms of FOK does not appear to vary by age. Individuals can be forced to rely on trace-access mechanisms for speeded FOK judgments.

The relation between psychometric test performance and physical performance in older adults.

BACKGROUND: The relationship between cognitive function and physical disability in nondemented older adults is not well characterized. The purpose of this study was to determine the relationship between performance on psychometric measures and a modified Physical Performance Test (modified PPT) in older men and women. METHODS: One hundred twenty-five men and women aged 75 years and older, who were enrolled in randomized, controlled trials of exercise or hormone replacement therapy, were recruited from the community-at-large and from congregate living sites. Measures obtained included Trailmaking A and B tests, Cancellation Random Figure tests, Weschler Associate Learning and 20-minute Delayed Recall, Verbal Fluency test, a modified PPT, and self-reports about performance of activities of daily living, medication use, and hospitalization in the previous year. RESULTS: Simple regression analysis demonstrated that speed of performance on the Trailmaking B and Cancellation Random Figure tests was significantly associated with total modified PPT score (r = .29, p < .001 and r = .36,p < .001, respectively). A factor analysis of the psychometric test battery demonstrated that two factors, a cognitive speed factor and a memory factor, accounted for 55% of the variance in cognitive test performance. Hierarchical multiple regression analyses demonstrated that age, number of medications, and the cognitive speed factor were independent predictors of total modified PPT score. CONCLUSIONS: Cognitive processing speed is a significant component of physical frailty in this population, although it accounts for a small percentage of variance on a standardized physical performance test.

Relating anatomy to function in Alzheimer's disease: neuropsychological profiles predict regional neuropathology 5 years later.

Neuropsychological profiles were assessed in a large group of nondemented control subjects (n = 261) and individuals with dementia of the Alzheimer type (DAT) (n = 407) by subjecting their psychometric test results to a factor analysis. Nondemented control subjects were functionally homogeneous with only one factor accounting for the results. The results of the factor analysis on the very mild DAT and mild DAT groups, however, yielded a mental control/frontal factor, a memory-verbal/temporal factor, and a visuospatial/parietal factor. Forty-one of the original set of participants came to autopsy an average of 5.1 years after psychometric testing and had neurofibrillary tangles, total senile plaques, and cored senile plaques estimated from frontal, temporal, and parietal regions. The results of correlations indicated that the relative burden of cored senile plaques was systematically related to the three psychometric factors. These results suggest a connection between the specific functions as defined by neuropsychological measures and specific neuropathology occurring in associated areas of cortex.

Differentiating drivers with dementia of the Alzheimer type from healthy older persons with a Traffic Sign Naming test.

BACKGROUND: Dementia may contribute significantly to the driving impairment commonly associated with older adults. A brief, reliable, and sensitive screening method to identify drivers who may have cognitive impairment due to Alzheimer's disease or other dementing illnesses is needed for a variety of settings, including driver's license renewal offices. METHODS: Control and demented individuals who participated in the Washington University Alzheimer's Disease Research Center (ADRC) between March 1, 1995, and November 30, 1995, were evaluated for the ability to identify traffic signs correctly. After initially testing 39 traffic signs, 10 signs were selected based on scorer reliability and their ability to discriminate cognitively normal individuals from those with dementia. RESULTS: Sixty-six cognitively normal older people (average age 78 years) and 70 people with dementia (average age 76 years) were tested. Using a cutoff score at or below 9 (out of a possible score of 20), the Traffic Sign Naming test successfully identifies 74% of people with mild or moderate dementia of the Alzheimer type (DAT) from cognitively healthy older persons of comparable age, sex, education, and socioeconomic status; 11% of the healthy drivers were misclassified as demented. CONCLUSIONS: A brief, 2-min or less, easily administered naming test of 10 traffic signs differentiated drivers with mild or moderate DAT from cognitively normal controls. This brief test may be useful to identify older drivers in need of further assessment of driving skill.

Temporal memory for remote events in healthy aging and dementia.

Memory for the temporal order of term of office of 7 past U.S. presidents was examined in healthy older adults and individuals in the early stages of dementia of the Alzheimer type (DAT). Among those individuals who recognized all 7 presidents, bow-shaped serial-position effects for temporal order similar to those seen in studies of short-term memory were observed for both the healthy group and the groups of individuals with dementia. Accuracy of temporal ordering decreased with increasing dementia severity. Thus, DAT affects 1 aspect of "old" memory (i.e., temporal information) even in the very early stages of the disease. Theoretical models of serial-position effects need to address remote memory as well as short-term memory.

Clinicopathologic studies in cognitively healthy aging and Alzheimer's disease: relation of histologic markers to dementia severity, age, sex, and apolipoprotein E genotype.

OBJECTIVE: To study differences between subjects with Alzheimer disease (AD) and cognitively intact control subjects, with respect to brain histologic markers of AD, and the relationship of those markers in the AD group to severity of dementia, age at death, sex, and apolipoprotein E genotype. SETTING: Washington University Alzheimer's Disease Research Center, St Louis, Mo. DESIGN AND SUBJECTS: Consecutive neuropathologic series of 224 prospectively studied volunteer research subjects, 186 with dementia of the Alzheimer type (DAT) or "incipient" DAT and confirmed to have AD by postmortem examination and 13 cognitively intact subjects, confirmed to lack postmortem findings of AD. MAIN OUTCOME MEASURES: Brain densities (number per square millimeter) of senile plaques and neurofibrillary tangles, extent of cerebral amyloid angiopathy, cortical Lewy bodies, and apolipoprotein E genotype. RESULTS: Neocortical neurofibrillary tangle densities were substantially correlated with dementia severity, and to a greater degree than was true for senile plaque densities. When infarcts, hemorrhages, and Parkinson disease changes coexisted with AD, neurofibrillary tangle and senile plaque densities were lower. Plaque-predominant AD was found in a greater proportion of subjects with milder than more severe dementia. Entorhinal cortical Lewy bodies were no more frequent in plaque-predominant AD than in the remaining AD cases. Increasing age at death was negatively correlated with dementia severity and densities of senile plaques and neurofibrillary tangles. The apolipoprotein E epsilon4 allele frequency was greater in AD than in control subjects but decreased with increasing age. After controlling for dementia severity, senile plaque densities were only weakly related to epsilon4 allele frequency, and only in hippocampus. However, the degree of cerebral amyloid angiopathy was clearly related to epsilon4 allele frequency. Among subjects diagnosed during life as having DAT or incipient DAT, only 7% were found to have a neuropathologic disorder other than AD causing their dementia. CONCLUSIONS: (1) The order of the strength of relationships between densities of histologic markers and dementia severity in AD is neurofibrillary tangles greater than cored senile plaques greater than total senile plaques. (2) Advanced age at death is associated with somewhat less severe dementia and fewer senile plaques and neurofibrillary tangles. (3) Plaque-predominant AD may represent a developmental stage in AD. (4) Despite a substantial effect of apolipoprotein E epsilon4 as a risk factor for AD, on decreasing the age at AD onset, and increasing the amount of cerebral amyloid angiopathy, its effect on senile plaque densities is variable and complex, being confounded with age, dementia severity, and methodologic differences. (5) Stringent clinical diagnostic criteria for DAT, even in the very mild stage, and senile plaque-based neuropathologic criteria for AD are highly accurate.

A prospective study of cognitive function and onset of dementia in cognitively healthy elders.

OBJECTIVE: To examine the earliest cognitive changes associated with the onset of dementia as well as changes associated with normal aging. DESIGN: Longitudinal evaluation of participants with annual clinical and psychometric examinations for up to 15 1/2 years. SETTING AND PARTICIPANTS: Elderly volunteers (n = 82) enrolled with a Clinical Dementia Rating of 0 (cognitively intact) in longitudinal studies. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Clinical Dementia Rating and results of a 1 1/2-hour psychometric battery. RESULTS: As estimated with survival analysis, 40% of participants had a Clinical Dementia Rating greater than 0 (cognitive decline) within 12 years of enrollment; 59% of these were judged to have dementia of the Alzheimer type or incipient dementia. Participants with poorer performance on psychometric testing at enrollment were at higher risk for cognitive decline subsequently. The rate of change in psychometric performance before clinically detectable cognitive change occurred was not significantly different between those who eventually developed dementia and those who remained stable, except for performance on the Logical Memory subtest of the Wechsler Memory Scale. When subtle cognitive decline was clinically detected, however, an abrupt deterioration in performance on independently administered psychometric tests was observed. CONCLUSIONS: Cognitively healthy elderly people maintain stable cognitive performance when measured longitudinally by both careful clinical evaluation and repeated psychometric testing. This stability is maintained unless and until they develop a dementing illness, at which time a sharp decline in performance is observed.

Prose recall in dementia. A comparison of delay intervals.

OBJECTIVE: To explore one methodological variation, delay length, that may contribute to contradictory findings in the literature regarding the use of delayed recall in the detection of early-stage dementia of the Alzheimer type. DESIGN: Comparison of participants with dementia and without dementia on a prose recall task at both 10- and 30-minute delay intervals. SETTING: Washington University Alzheimer's Disease Research Center, St Louis, Mo. PARTICIPANTS: Participants with very mild dementia of the Alzheimer type (n = 136) and uncompromised elderly individuals (n = 197). MAIN OUTCOME MEASURES: Results of the Logical Memory subtest from the Wechsler Memory Scale with immediate recall and 10- and 30-minute delayed recall. RESULTS: Participants with dementia recalled significantly less material than elderly controls at both immediate and delayed recall (P < .001). Multiple regression analyses revealed that dementia classification failed to account for additional variance in the 30-minute delayed score beyond that which could be accounted for by the immediate score. A small but significant proportion of variance was accounted for in the 10-minute delayed score beyond that which could be accounted for by the immediate recall score. CONCLUSION: Delayed recall of a prose passage does not appear to enhance the differentiation of very mild dementia of the Alzheimer type from normal aging in a meaningful way, whether the recall delay is 10 or 30 minutes.

Cerebral amyloid deposition and diffuse plaques in "normal" aging: Evidence for presymptomatic and very mild Alzheimer's disease.

The presence of senile plaques in the neocortex of apparently nondemented elderly persons often is accepted as part of "normal" aging. Alternatively, because cerebral deposition of beta-amyloid may be a key mechanism in the development of Alzheimer's disease (AD), the presence of beta-amyloid-containing plaques may represent very early AD. To examine the relationships of cognitively normal aging, very mild dementia of the Alzheimer type, and the presence of neocortical senile plaques, we performed clinicopathologic correlation in 21 longitudinally studied healthy elderly subjects (84.5 +/- 6.6 years old at death). Nine subjects had strikingly high plaque densities in the neocortex; two of these subjects died of head injury before which there was no evidence of cognitive impairment. The other seven subjects with high plaque densities had clinical evidence for very mild cognitive impairment (Clinical Dementia Rating score of 0.5) at some time during their course and mildly impaired psychometric performance at last assessment before death. The remaining 12 subjects had no clinical or psychometric impairment and had few or no neocortical AD lesions. These results suggest that senile plaques may not be part of normal aging but instead represent presymptomatic or unrecognized early symptomatic AD. The high density of senile plaques (predominately of the diffuse subtype) in the cortex of subjects just at the threshold of detectable dementia is consistent with the hypothesis that beta-amyloid deposition is an initial pathogenetic event in the development of AD.

Relations among age, exercise, and psychological variables in a community sample of women.

Age, exercise status, and their interaction were examined in relation to self-motivation, exercise self-efficacy, and attitudes toward exercise among a community sample of women aged 20 to 85 years. Random digit telephone dialing yielded 121 participants, stratified by age and exercise status. Age was negatively related to attitudes toward exercise and exercise self-efficacy but was unrelated to self-motivation. Age also interacted with exercise status; the belief that exercise would be enjoyable and beneficial decreased with increasing age only among nonexercisers. Finally, exercisers were significantly more self-motivated, had greater exercise self-efficacy, and had more positive attitudes toward exercise than did nonexercisers.

Auditory dysfunction in aging and senile dementia of the Alzheimer's type.

OBJECTIVE: To determine the prevalence and type of auditory dysfunction in older volunteer subjects with mild probable Alzheimer's disease (pAD). METHODS: Pure-tone thresholds, word recognition in quiet, Synthetic Sentence Identification with Ipsilateral Competing Message or Contralateral Competing Message, distortion-product otoacoustic emissions, and auditory brain-stem responses were done in 82 elderly volunteer subjects whose cognitive, psychologic, and neurologic status had been determined through annual testing in a research center. Based on clinical criteria and the Clinical Dementia Rating (CDR) scale, 40 subjects had been judged to be nondemented (CDR score, 0), and 42 had a clinical diagnosis of pAD, with 22 in the questionable (CDR score, 0.5) and 20 in the mild (CDR score, 1) categories. RESULTS: The mean age-adjusted pure-tone average thresholds (0.5, 1.0, and 2.0 kHz) were poorer in the subjects with pAD by 5.1 dB in the right ears and 6.1 dB in the left ears; these differences were not statistically significant. Word recognition in quiet did not differ by CDR category. The age-adjusted scores on the Synthetic Sentence Identification with Ipsilateral Competing Message or Contralateral Competing Message were significantly reduced in the subjects with mild pAD. Distortion-product otoacoustic emission amplitudes and auditory brain-stem response thresholds and latencies paralleled the pure-tone threshold results and did not differ across the CDR groups. CONCLUSIONS: Central auditory dysfunction was evident in subjects with even mild cases of pAD, whereas peripheral auditory function was not different from that in age-matched control subjects. Additional research is needed to delineate the mechanisms of central auditory dysfunction and to establish the sensitivity and specificity of auditory testing in subjects with Alzheimer's disease. We recommend auditory assessment, including Synthetic Sentence Identification with Ipsilateral Competing Message or Contralateral Competing Message, for older patients in general and in particular for those in whom dementia is suspected.

Visuospatial deficit in dementia of the Alzheimer type.

OBJECTIVE: To examine visuospatial impairment in a task that minimizes episodic memory demands in individuals with very mild or mild dementia of the Alzheimer type compared with a healthy control group. DESIGN: Initial scores on the Visual Form Discrimination Test enrolled in longitudinal studies of dementia of the Alzheimer type and healthy aging. SETTING: Alzheimer's Disease Research Center at Washington University, St Louis, Mo. PARTICIPANTS: Volunteer samples of 59 people (35 women and 24 men) with mild dementia of the Alzheimer type, 66 (39 women and 27 men) with mild dementia of the Alzheimer type, and 146 healthy nondemented individuals (90 women and 56 men) were recruited between 1988 and 1992. Ages ranged from 51 to 96 years. Persons with confounding medical, neurologic, or psychiatric disorders were excluded. Dementia severity was staged by means of the Clinical Dementia Rating. MAIN OUTCOME MEASURES: Total number correct on the Visual Form Discrimination Test as well as the numbers of three types of errors: peripheral figure movement or rotation, major figure distortion, and major figure rotation. RESULTS: Visuospatial deficit was apparent in very mild dementia of the Alzheimer type. Individuals with both very mild and mild dementia of the Alzheimer type made more errors involving peripheral figures and rotation of a major figure than did healthy, nondemented individuals. CONCLUSION: The initial effects of Alzheimer's disease on cognitive function are more pervasive than just episodic memory failure.

Sex differences in the sensitivity of two self-report depression scales in older depressed inpatients.

Both the Geriatric Depression Scale (J. A. Yesavage et al., 1983) and the Beck Depression Inventory (A. T. Beck, A. J. Rush, B. F. Shaw, & G. Emery, 1979) were less effective in identifying depressed men than women in a sample of 191 geriatric psychiatric inpatients with major unipolar depression. From one quarter to one half of the men were missed cases, depending on the cutoff score used. Separate cutoff scores for older men and women on depression screening instruments may be appropriate.