To evaluate the specificity of the semantic fluency deficit in Alzheimer's disease (AD), we compared the performances of patients with AD, Huntington's disease (HD), vascular dementia (VD), and healthy control subjects on tasks of category (i.e., semantic) and first-letter (i.e., phonemic/lexical) word list generation. As compared to age-appropriate controls, all three patient groups demonstrated relatively more impaired semantic than phonemic fluency. Dementia severity did not affect this relationship. Thus, the greater vulnerability of semantically guided fluency is not specific to AD but occurs in other dementias as well. Deficits in both the organization of semantic memory and retrieval from long-term storage appear to contribute to the relatively poorer performance on semantic than phonemic fluency tasks observed in patients with AD, VD, and HD.
SUMMARYThe purpose of this study was to determine whether cognitive test performances alone could distinguish patients with probable Alzheimer's disease from those with probable vascular dementia. Sixty-eight outpatients with clinical diagnoses of either Alzheimer's disease or vascular dementia were administered a brief battery of neuropsychological tests. Scores from the Boston Naming Test and the Hopkins Verbal Learning Test were identified as most discriminating of the groups. Seventy-seven per cent of the sample was correctly classified by a stepwise discriminant function analysis. Results of this study indicate that selected neuropsychological tests have moderate concurrent utility in the differential diagnosis of dementia.KEY woRDs-Alzheimer's disease, vascular dementia, neuropsychological tests, discriminant analysis.Alzheimer's disease (AD) is the cause of at least 50% of all cases of dementia in the elderly (Forster and Martin, 1990;Terry and Katzman, 1983). Its prevalence has been estimated at 10% of those over age 65 years (Evans et al., 1989). Jorm et al. (1987) determined that the prevalence of AD is 1.4% at age 65 years, with a doubling of this rate for every five years of age. Vascular dementia (VD) is the second most common cause of dementia in the elderly (Forster and Martin, 1990;Wisniewski and Terry, 1976) and can result from many different types of cerebrovascular disease (Funkenstein, 1988;Hachinski et al., 1975). Together, AD and VD are believed to account for at least 85% of all cases of dementia in postmortem studies (Bucht and Adolfsson, 1983;Wisniewski and Terry, 1976 are lacking, and no weight is given to the results of neuroimaging studies, which are often relied upon heavily in clinical decision-making (Funkenstein, 1988). Hachinski et al. (1975) also did not validate their clinical diagnoses (which were determined by Hachinski ischemia scores) against pathological evidence, although Rosen et al. (1 980) did so with a revised Hachinski score. Thus, discrimination of AD from multi-infarct dementia remains problematic, as does the differentiation of AD from cerebrovascular dementias generally. A valid and cost-effective way of discriminating VD from AD is still needed in order to more adequatelydiagnose, and hence manage, patients with dementia.Several studies have successfully distinguished demented patients (of varying etiologies) from healthy subjects with the use of neuropsychological tests alone (Eslinger et al., 1985;Storandt et al., 1984). Others have attempted to distinguish the cognitive profiles of AD patients from VD patients or those with other types of dementia (Hagberg and Gustafson, 1985;Olafsson et al., 1989;Parlato et al., 1990;Perez et al., 1975a Perez et al., , b, 1976Perez et al., , 1978 Tierney et ul., 1987). These studies have met with mixed success, due, in part, to great within-group variability. Specifically, the distribution of infarcts in VD patients is heterogeneous (Hagberg and Gustafson, 1985), as is the distribution of senile plaques and 08854230/92/0Y...
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