A quantitative review of the diagnostic utility of the WAIS-R Fuld profile

The prevalence of Fuld's WAIS "cholinergic deficit" profile has been examined in 18 studies, in which the profiles of over 3700 subjects have been evaluated. When these data were pooled, it was found that the profile's sensitivity to dementia of the Alzheimer type (DAT) was only 24.1%; 77 of 319 DAT patients evaluated across seven studies displayed the Fuld profile. The profile's specificity was considerably better than its sensitivity; 93.3% (2256/2418) of normals had "negative" profiles, as did 88.5% (1058/1198) of non-DAT patients (e.g., patients with multi-infarct dementia). With its poor sensitivity, the profile's diagnostic utility under different base rate conditions was unimpressive. Memory indices possess far greater sensitivity to DAT, and have been shown to reliably differentiate DAT from many other causes of cognitive dysfunction. It was recommended that future diagnostic studies of DAT should evaluate whether additional neuropsychological measures, such as WAIS-R indices, enhance the diagnostic accuracy achieved by memory measures.