Primary or depressive dementia: Psychometric assessment

The Neuropsychological Differentiation of Patients with Very Mild Alzheimer's Disease and/or Major Depression

“…Our results corroborate reports suggesting the ability to retain information over a short period of time may be one of the best ways to discriminate among patients who, for a number of reasons, may not be readily distinguished on tests of immediate recall 57–60,83,87,104,105 . A further stepwise logistic regression analysis on AD group membership, displayed in Table 6, showed that, unlike in the recent report by Robin‐son‐Whelen and Storandt, 106 the measure of retention was more important than the initial registration in identifying true positives; this adds credence to other surveys that have suggested forgetting may be a better discriminator of mild dementia 55,58,67,107 and correlates best with brain atrophy indices 88,108 . One difference with Robinson‐Whelen and Storandt's study is that their analysis included only healthy subjects as controls, whereas half of the NOAD cases in our analysis were depressed older adults.…”

“…Research describing statistical 57–59 or meta‐analytical 60,61 results now converge in suggesting the best way to detect AD patients in its mildest stages is to deploy tests of memory functions in which the requirements for semantic processing are highlighted 62–64 . Although experimental studies exist incidentally reporting on patients’ results with standardized neuropsychological tests given in the initial work‐up, 65,66 little is available in these accounts to evaluate the measures’ success on a single‐case basis, and psychometric studies are now needed to document how successful these neuropsychological tests can be in routine clinical assessment 67,68 . The aim of this paper was to examine the ability of neuropsychological tests commonly used in tertiary services to clinically differentiate depressed patients with cognitive impairments from AD patients with and without major depression.…”

Primary or depressive dementia: Clinical features

“…In a landmark paper, Wells (1979) drew up a table of 'major clinical features differentiating pseudodementia from dementia' but the inventory did not exclusively focus on depressed organic patients. While the benefits of neurodiagnostics and other ancillary procedures (eg laboratory tests, psycho- metrics) were briefly considered in the text, these were the subject of recent articles (desRosiers, 1992a;Ferrier et al, 1991;Guze et al, 1991;Have et al, 1991;Kolbeinsson et al, 1992;Zubenko et al, 1990) and the emphasis here will remain on Wells' table. Table 2 reproduces Wells' original list of criteria and conclusions while the sections below examine the validity of some of its items from evidence published since the last reviews (Bulbena and Berrios, 1986;Mahendra, 1987).…”