Assessment of nondeclarative learning in severe Alzheimer dementia: the Implicit Memory Test (IMT)

Although patients with Alzheimer dementia (AD) have impaired explicit memory, more automatic, implicit aspects of learning and memory may be relatively preserved. However, neuropsychological tests for the assessment of implicit memory are lacking. This study examines a newly developed test, the Implicit Memory Test, in 28 patients with severe AD (mini-mental state examination 5 to 12) and 22 cognitively unimpaired matched controls (mini-mental state examination 25 to 29). The Implicit Memory Test consists of visually presented word (stem-completion) and picture (fragmented picture identification) subtests, each comprising 3 learning trials and a delayed test. Explicit memory was also assessed, using the verbal paired-associate learning subtest from the Wechsler Memory Scale and the Visual Association Test. Patients with AD obtained a floor performance on both explicit memory tests, whereas a significant learning curve was found for both the stem-completion and the fragmented pictures subtests of the Implicit Memory Test. Delayed testing on the fragmented pictures subtest showed a preserved performance that may have been mediated by implicit learning. Delayed performance on the stem-completion subtest, however, showed clear memory decay that suggests contamination by explicit memory function, at least in the controls. These findings extend the earlier results on word-stem completion and fragmented picture identification in patients with mild-to-moderate AD and indicate that residual learning capacity can be assessed in severe AD.