Clinical investigations in primary care

Area of Science:

• Neurology
• Neuroscience
• Geriatrics

Background:

• Alzheimer's disease (AD) is the leading cause of dementia, characterized by progressive neurodegeneration.
• Early symptoms include significant decline in cognitive function, especially episodic memory, indicative of medial temporal lobe impairment.
• As AD progresses, patients experience language deficits, visuospatial and executive dysfunction, and neuropsychiatric disturbances, leading to loss of autonomy.

Purpose of the Study:

• To outline the diagnostic approach for Alzheimer's disease (AD).
• To highlight the role of neuropsychological evaluation, particularly the Free and Cued Selective Reminding Test (FCSRT), in identifying the amnestic syndrome characteristic of AD.
• To emphasize the importance of considering other cognitive domains and ruling out confounding medical conditions.

Main Methods:

• Clinical diagnosis based on comprehensive medical and neuropsychological examinations.
• Utilizing the Free and Cued Selective Reminding Test (FCSRT) to assess free and cued recall, identifying deficits specific to medial temporal lobe dysfunction.
• Employing additional neuropsychological tests to evaluate executive functions, praxis, visuospatial abilities, and language.
• Integrating neuroimaging and biological markers (genetics, biomarkers) for enhanced diagnostic utility.
• Conducting thorough investigations for other potential causes of memory impairment.

Main Results:

• The amnestic syndrome of the medial temporal type in AD is characterized by poor free recall and reduced total recall due to ineffective cueing.
• Neuropsychological testing reveals deficits across various cognitive domains beyond memory.
• Neuroimaging and biomarkers provide valuable supplementary diagnostic information.

Conclusions:

• Clinical diagnosis of AD relies on a multi-faceted approach combining medical history, detailed neuropsychological assessment, and potentially neuroimaging and biomarkers.
• The FCSRT is a key tool for detecting the specific memory impairment pattern in AD.
• Differential diagnosis is crucial to exclude other conditions that may mimic AD symptoms.