Skip to main content Accessibility help

The utility of a non-verbal prospective memory measure as a sensitive marker for early-stage Alzheimer's disease in Hong Kong

  • C. S. Tse (a1), J. F. Chang (a2), Ada W. T. Fung (a3), Linda C. W. Lam (a3), K. T. Hau (a1), Grace T. Y. Leung (a3) and D. A. Balota (a4)...



With the proportion of older adults in Hong Kong projected to double in size in the next 30 years, it is important to develop measures for detecting individuals in the earliest stage of Alzheimer's disease (AD, 0.5 in Clinical Dementia Rating, CDR). We tested the utility of a non-verbal prospective memory task (PM, ability to remember what one has to do when a specific event occurs in the future) as an early marker for AD in Hong Kong Chinese.


A large community dwelling sample of older adults who are healthy controls (CDR 0, N = 125), in the earliest stage of AD (CDR 0.5, N = 125), or with mild AD (CDR 1, N = 30) participated in this study. Their reaction time/accuracy data were analyzed by mixed-factor analyses of variance to compare the performance of the three CDR groups. Logistic regression analyses were performed to test the discriminative power of these measures for CDR 0 versus 0.5 participants.


Prospective memory performance declined as a function of AD severity: CDR 0 > CDR 0.5 > CDR 1, suggesting the effects of early-stage AD and AD progression on PM. After partialling out the variance explained by psychometric measures (e.g., ADAS-Cog), reaction time/accuracy measures that reflected the PM still significantly discriminated between CDR 0 versus 0.5 participants in most of the cases.


The effectiveness of PM measures in discriminating individuals in the earliest stage of AD from healthy older adults suggests that these measures should be further developed as tools for early-stage AD discrimination.


Corresponding author

Correspondence should be addressed to: C. S. Tse, Department of Educational Psychology, The Chinese University of Hong Kong, Shatin, N. T., Hong Kong. Phone: +852-39436751; fax: +852-26036921. E-mail:


Hide All
Albert, M., Moss, M. B., Blacker, D., Tanzi, R. and McArdle, J. J. (2007). Longitudinal change in cognitive performance among individuals with mild cognitive impairment. Neuropsychology, 21, 158169.
Aschenbrenner, A. J. et al. (in press). Alzheimer disease biomarkers, attentional control and semantic memory retrieval: synergistic and mediational effects of biomarkers on a sensitive cognitive measure in non-demented older adults. Neuropsychology.
Blanco-Campal, A., Coen, R. F., Lawlor, B. A., Walsh, J. B. and Burke, T. E. (2009). Detection of prospective memory deficits in mild cognitive impairment of suspected Alzheimer's disease etiology using a novel event-based prospective memory task. Journal of International Neuropsychological Society, 15, 154159.
Burgess, P. W., Quayle, A. and Frith, C. D. (2001). Brain regions involved in prospective memory as determined by positron emission tomography. Neuropsychologia, 39, 545555.
Camp, C. J., Foss, J. W., Stevens, A. B. and O’Hanlon, A. M. (1996). Improving prospective memory task performance in persons with Alzheimer's disease. In Brandimonte, M., Einstein, G. O. and McDaniel, M. A. (eds.), Prospective Memory: Theory and Applications (pp. 351367). New Jersey: Lawrence Erlbaum Associates.
Chan, R. C., Qing, Y., Wu, Q. and Shum, D. (2010). Prospective memory in healthy Chinese people: the latent structure of the comprehensive assessment of prospective memory questionnaire. Neuropsychological Rehabilitation, 20, 459470.
Chang, J. F. et al. (2014). Bias in discriminating very mild dementia for older adults with different levels of education in Hong Kong. International Psychogeriatrics, 26, 9951010.
Costa, A. et al. (2010). Prospective memory functioning in mild cognitive impairment. Neuropsychology, 24, 327335.
Crawford, J. R., Henry, J. D., Ward, A. L. and Blake, J. (2006). The prospective and retrospective memory questionnaire (PRMQ): latent structure, normative data and discrepancy analysis for proxy-ratings. British Journal of Clinical Psychology, 45, 83104.
Duchek, J. M., Balota, D. A. and Cortese, M. (2006). Prospective memory and apolipoprotein E in healthy aging and early stage Alzheimer's disease. Neuropsychology, 20, 633644.
Duchek, J. M., Balota, D. A., Tse, C.-S., Holtzman, D. M., Fagan, A. M. and Goate, A. M. (2009). The utility of intraindividual variability in selective attention tasks as an early marker for Alzheimer's disease. Neuropsychology, 23, 746758.
Gao, J. L., Cheung, R. T. F., Chan, Y. S., Chu, L. W. and Lee, T. M. C. (2013). Increased prospective memory interference in normal and pathological aging: different roles of motor and verbal processing speed. Aging, Neuropsychology, and Cognition, 20, 80100.
Hong Kong Census and Statistics Department. (2011). Population Census 2011. Retrieved from
Huppert, F. A., Johnson, T. and Nickson, J. (2000). High prevalence of prospective memory impairment in the elderly and in early-stage dementia: findings from a population-based study. Applied Cognitive Psychology, 14, 6381.
Hutchison, K. A., Balota, D. A. and Duchek, J. M. (2010). The utility of stroop task switching as a marker for early stage Alzheimer's disease. Psychology and Aging, 25, 545559.
Jalbert, J. J., Daeillo, L. A. and Lapane, K. L. (2008). Dementia of the Alzheimer type. Epidemiologic Reviews, 30, 1534.
Karantzoulis, S., Troyer, A. K. and Rich, J. B. (2009). Prospective memory in amnestic mild cognitive impairment. Journal of International Neuropsychological Society, 15, 407415.
Lam, L. C. W., Lui, V. W. C., Tam, C. W. C. and Chiu, H. F. (2005). Subjective memory complaints in Chinese subjects with mild cognitive impairment and early Alzheimer's disease. International Journal of Geriatric Psychiatry, 20, 876882.
Lam, L. C. W. et al. (2008). Use of clinical dementia rating in detecting early cognitive deficits in a community-based sample of Chinese older persons in Hong Kong. Alzheimer Disease and Associated Disorder, 22, 153157.
Lam, L. C. W. et al. (2010).Combined clinical and cognitive criteria to identify mild cognitive impairment in a southern chinese community. Alzheimer Disease and Associated Disorders, 24, 343347.
Martins, S. P. and Damasceno, B. P. (2008). Prospective and retrospective memory in mild Alzheimer's disease. Arquivos de Neuro Psiquiatria, 66, 318322.
Martins, S. P. and Damasceno, B. P. (2012). Accuracy of prospective memory tests in mild Alzheimer's disease. Arquivos Neuropsiquiatria, 70, 1721.
McDaniel, M. A. and Einstein, G. O. (2007). Prospective Memory: An Overview and Synthesis of an Emerging Field, Thousand Oaks, CA: Sage Publications
McDaniel, M. A., Shelton, J. T., Breneiser, J. E., Moynan, S. and Balota, D. A. (2011). Focal and nonfocal prospective memory performance in very mild dementia: a signature decline. Neuropsychology, 25, 387396.
Morris, J. C. et al. (1997). Clinical dementia rating (CDR) training and reliability protocol: the Alzheimer's disease cooperative study unit experience. Neurology, 48, 15081510.
Petersen, R. C., Stevens, J. C., Ganguli, M., Tangalos, E. G., Cummings, J. L. and DeKosky, S. T. (2001). Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Neurology, 56, 11331142.
Storandt, M. (2008). Cognitive deficits in the early stages of Alzheimer's disease. Current Directions in Psychological Science, 17, 198202.
Storandt, M., Grant, E. A., Miller, J. P. and Morris, J. C. (2006). Longitudinal course and neuropathologic outcomes in original versus revised MCI and in pre-MCI. Neurology, 67, 467473.
Thompson, C., Henry, J. D., Rendell, P. G., Withall, A. and Brodaty, H. (2010). Prospective memory function in mild cognitive impairment and early dementia. Journal of International Neuropsychological Society, 16, 318325.
Troyer, A. K. and Murphy, K. J. (2007). Memory for intentions in amnestic mild cognitive impairment: time- and event-based prospective memory. Journal of International Neuropsychological Society, 13, 365369.
Tse, C.-S., Balota, D. A., Moynan, S. C., Duchek, J. M. and Jacoby, L. L. (2010a). The utility of placing recollection in opposition to familiarity in early discrimination of healthy aging and very mild dementia of the Alzheimer's type. Neuropsychology, 24, 4967.
Tse, C.-S., Balota, D. A., Yap, M. J., Duchek, J. M. and McCabe, D. P. (2010b). Effects of healthy aging and early-stage dementia of the Alzheimer's type on components of response time distributions in three attention tasks. Neuropsychology, 24, 300315.
Tse, C.-S. et al. (2013). Effects of education on very mild dementia among Chinese people in Hong Kong: potential mediators in the cantonese mini-mental state examination (C-MMSE) tasks. Aging and Mental Health, 17, 310318.
U.S. Department of Health and Human Services. (2011). A Profile of Older Americans: 2011, Retrieved from
Zhou, T., Broster, L. S., Jiang, Y., Bao, F., Wang, H. and Li, J. (2012). Deficits in retrospective and prospective components underlying prospective memory tasks in amnestic mild cognitive impairment. Behavioral and Brain Functions, 8, 39.


Type Description Title
Supplementary materials

Tse Supplementary Material

 Word (102 KB)
102 KB

The utility of a non-verbal prospective memory measure as a sensitive marker for early-stage Alzheimer's disease in Hong Kong

  • C. S. Tse (a1), J. F. Chang (a2), Ada W. T. Fung (a3), Linda C. W. Lam (a3), K. T. Hau (a1), Grace T. Y. Leung (a3) and D. A. Balota (a4)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed