Melbourne School of Psychological Sciences - Theses

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Start date: 1980 × End date: 1999 × Author: Fowler, Kylie Sarah ×

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    Early neuropsychological change in possible dementia of the Alzheimer type
    Fowler, Kylie Sarah ( 1996)
    Early detection of dementia of the Alzheimer type (DAT) is vital in understanding the natural course of the disease, which in turn guides the development of potential pharmacological treatment and management strategies. However, early detection of DAT has traditionally proved difficult. The study described in this thesis comprehensively examined neuropsychological function over a 24 month period in patients with early dementia, using as comparison groups individuals with isolated memory complaints (questionable dementia, QD), and normal controls. The neuropsychological battery utilised included standard measures of cognition, such as the WAIS-R and WMS-R, and experimentally-derived computerised tests of memory. The same pattern of neuropsychological change was exhibited by patients with early DAT and by QD subjects who later fulfilled standard criteria for the disease. In both groups pronounced impairment of recent memory preceded deficits in language and visuospatial function. The progression of cognitive deterioration observed in DAT is likely to reflect the spread of neuropathology throughout the cortex. In view of these findings, the selection of appropriate neuropsychological measures for the detection and staging of early DAT is discussed. One computerised measure, the paired associate learning test, was found to be particularly efficacious in the prediction and early detection of DAT. The QD group performed at a similar level to normal controls when first assessed using the paired associate learning subtest. However, over the course of the study, 43% of the QD subjects exhibited significant deterioration in scores on this measure. All subjects who deteriorated on the computerised paired associate learning task met standard criteria for DAT at the conclusion of the study. Diagnosis of probable DAT was not predicted by any other demographic or psychometric variable. These findings are discussed in terms of the special sensitivity of the associate learning paradigm to the neuropathology of Alzheimer's disease.