[A comparison of the performances between healthy older adults and persons with Alzheimer's disease on the Rey auditory verbal learning test and the Test de rappel libre/rappel indicé 16 items]. / Comparaison des performances à l'épreuve des 15 mots de Rey et au RL/RI 16 dans le vieillissement normal et la démence de type Alzheimer.

The aim of this research was to compare the performances of healthy elderly (n=40) and individuals with Alzheimer's disease (AD, n=40) on the RL/RI 16, a French adaptation of the Free and cued selective reminding test (FCSRT) and on the Rey auditory verbal learning test (RAVLT). These two verbal episodic memory tests are frequently used in clinical practice in French-speaking populations. Results showed that the RAVLT demonstrated a slightly better sensitivity and sensibility than the RL/RI 16. The RAVLT allowed to classify participants of the two groups without any overlap. Moreover, no floor effect was observed in the RAVLT in AD and ceiling effects were less pronounced in normal controls that in the RL/RI 16. Results observed in the RL/RI 16 showed important ceiling effects and a decline in performance on free recall throughout trials in AD patients. Nonetheless, the latter tool was less sensitive to recency effects than the RAVLT and may thus provide a more realistic view of the long-term memory performance of these patients. The semantic cues provided in the RL/RI 16 appeared to increase intrusions in AD whereas the interference list in the RAVLT was the first source of false recognitions in both healthy elderly and AD. In conclusion, this paper demonstrates both the advantages and disadvantages of these two tools in the evaluation of episodic memory in elderly with and without cognitive deficits.

Diagnosis and treatment of dementia: 3. Mild cognitive impairment and cognitive impairment without dementia.

BACKGROUND: Mild cognitive impairment and cognitive impairment, no dementia, are emerging terms that encompass the clinical state between normal cognition and dementia in elderly people. Controversy surrounds their characterization, definition and application in clinical practice. In this article, we provide physicians with practical guidance on the definition, diagnosis and treatment of mild cognitive impairment and cognitive impairment, no dementia, based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, held in March 2006. METHODS: We developed evidence-based guidelines using systematic literature searches, with specific criteria for study selection and quality assessment, and a clear and transparent decision-making process. We selected studies published from January 1996 to December 2005 that had mild cognitive impairment or cognitive impairment, no dementia, as the outcome. Subsequent to the conference, we searched for additional articles published between January 2006 and January 2008. We graded the strength of evidence using the criteria of the Canadian Task Force on Preventive Health Care. RESULTS: We identified 2483 articles, of which 314 were considered to be relevant and of good or fair quality. From a synthesis of the evidence in these studies, we made 16 recommendations. In brief, family physicians should be aware that most types of dementia are preceded by a recognizable phase of mild cognitive decline. They should be familiar with the concepts of mild cognitive impairment and of cognitive impairment, no dementia. Patients with these conditions should be closely monitored because of their increased risk for dementia. Leisure activities, cognitive stimulation and physical activity could be promoted as part of a healthy lifestyle in elderly people and those with mild cognitive impairment. Vascular risk factors should be treated optimally. No other specific therapies can yet be recommended. INTERPRETATION: Physicians will increasingly see elderly patients with mild memory loss, and learning an approach to diagnosing states such as mild cognitive impairment is now warranted. Close monitoring for progression to dementia, promotion of a healthy lifestyle and treatment of vascular risk factors are recommended for the management of patients with mild cognitive impairment.

Mild cognitive impairment and cognitive impairment, no dementia: Part A, concept and diagnosis.

Mild cognitive impairment (MCI) and cognitive impairment, no dementia (CIND) are controversial emerging terms that encompass the clinical state between elderly normal cognition and dementia. This article reviews recent work on the classification of MCI and CIND, their prognosis, and diagnostic approaches and presents evidence-based recommendations approved at the meeting of the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD3) held in Montreal in March, 2006. New short tools such as the Montreal Cognitive Assessment are making it easier for family physicians to confidently attach the label of MCI.