Alzheimer disease

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Abstract

Memory testing beyond the 3-word recall of brief mental status examinations is not routinely performed on patients with memory complaints. This is due to time constraints and uncertainty over how to conduct and interpret a valid learning and memory examination. Failure to evaluate memory complaints consistently with objective assessments has no doubt contributed to the impression that memory testing lacks specificity for Alzheimer disease (AD). Memory disorders specialists who frequently diagnose AD recognize the value of a targeted memory examination. In this issue of Neurology ®, Wagner et al.1 reinforce this by using memory tests that specifically probe mesiotemporal function in elderly individuals with memory deficits, demonstrating that these tests predict CSF Aβ42/tau levels. The authors found that subjects who performed poorly on tests of mesiotemporal function had low CSF Aβ42/tau ratios. Other studies have shown low CSF Aβ42/tau ratios, in turn, associate with AD.2 By establishing a neuroanatomic localization for the patient's complaint, therefore, an appropriately applied memory examination essentially changes AD from a diagnosis of exclusion to one of inclusion. For elderly individuals with memory complaints, bilateral mesiotemporal dysfunction is usually due to AD. The authors studied subjects with mild cognitive impairment (MCI), and analyzed data from CSF biomarker testing, the logical memory paragraph recall test from the Wechsler Memory Scale–Revised (LM), the word list learning task from the Consortium to Establish a Registry …