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A comparison of the Addenbrooke's Cognitive Examination (ACE), conventional neuropsychological assessment and simple MRI-based medial temporal lobe evaluation in the early diagnosis of Alzheimer's Disease
Galton, C.J., ERZINCLIOGLU, S., Sahakian, B.J., Antoun, N. & HODGES, J.R.
Cognitive and Behavioral Neurology 18(3), 144-150
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Objective: To examine the contribution of the Addenbrooke’s Cognitive Examination (ACE), neuropsychological assessment and an MRI-based temporal lobe rating scale to the prediction of which patients with questionable dementia will progress to Alzheimerís disease (AD). Methods: 50 subjects (19 early AD, 31 questionable dementia, QD) underwent the ACE, a neuropsychological evaluation and a volumetric MRI. The degree of atrophy of hippocampal, parahippocampal and other temporal lobe structures was assessed using a validated visual rating scale. Subjects were followed 8 monthly for an average of 19.1 months. Results: Of the 31 QD subjects, 11 converted to AD within 24 months of follow up (another 2 developed dementia with Lewy bodies) and 18 were non-converters. Converters were impaired, relative to non-converters at baseline on measures of episodic and semantic memory (category fluency and naming) and the ACE. Converters also had a greater degree of hippocampal and parahippocampal atrophy. Discriminant analysis demonstrated that the best single test for distinguishing converters was the ACE. In combination, the hippocampal rating and category fluency were also contributory. Conclusions: Progression to AD in patients with questionable dementia is best predicted by neuropsychological measures particularly those that assess episodic and semantic memory although simple rating methods based on MRI may have an adjunctive role.