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Impairments in learning and recall have been well established in amnestic mild cognitive impairment (aMCI). However, a relative dearth of studies has examined the profiles of memory strategy use in persons with aMCI relative to those with Alzheimer's disease (AD). Participants with aMCI, nonamnestic MCI, AD, and healthy older adults were administered the California Verbal Learning Test-II (CVLT-II). Measures of semantic clustering and recall were obtained across learning and delayed recall trials. In addition, we investigated whether deficits in semantic clustering were related to progression from healthy aging to aMCI and from aMCI to AD. The aMCI group displayed similar semantic clustering performance as the AD participants, whereas the AD group showed greater impairments on recall relative to the aMCI participants. Control participants who progressed to aMCI showed reduced semantic clustering at the short delay at baseline compared to individuals who remained diagnostically stable across follow-up visits. These findings show that the ability to engage in an effective memory strategy is compromised in aMCI, before AD has developed, suggesting that disruptions in semantic networks are an early marker of the disease. (JINS, 2014, 20, 1–11)
Neuropsychiatric symptoms are a common problem in dementia. Epidemiological studies indicate that approximately 60% of demented subjects in the community exhibit some degree of psychopathology. Among specific populations of subjects diagnosed with frontotemporal dementia (FTD) or advanced Alzheimer's disease (AD), the prevalence of behavioral pathology increases to 95%. The most frequently reported behavioral symptoms include apathy, agitation and depression.
The significant contributions of neuropsychiatric symptoms to the more common dementia syndromes are reflected by their prominent role in the diagnosis of these conditions. Behavioral symptoms are primary components of the diagnostic criteria for FTD and dementia with Lewy bodies (DLB) and are among the secondary supportive factors in the diagnostic criteria for AD and vascular dementia (VaD). Disturbances in behavior have also been reported in mild cognitive impairment (MCI), Parkinson's disease with dementia (PDD), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD).
While the severity of a dementing illness is often determined using cognitive criteria, behavioral disturbances are responsible for a substantial proportion of the morbidity caused by different dementia syndromes. Caregivers for patients with dementia find behavioral abnormalities significantly more troubling than cognitive deficits. The presence of neuropsychiatric symptoms correlates with increased rates of institutionalization, cost of care and caregiver stress and burden.
The behavioral disruptions seen in dementia are not simply an inevitable consequence of worsening cognitive impairment. Although neuropsychiatric symptoms are often seen with greater frequency and severity in the later stages of dementing illnesses, the clinical course of different behavioral symptoms is often heterogeneous and does not correlate closely with the severity of cognitive or functional impairment.
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