Delayed associative memory and recall error patterns in mild cognitive impairment: discriminant capacity of the Italian face-name association test

Cross-modal associative memory impairment is one of the earliest cognitive markers of neurodegenerative disorders and may be particularly sensitive to the detection of Mild Cognitive Impairment (MCI). The Italian Face-Name Association Test (ItFNAT) assesses face-name associative memory through immediate recall (IR), delayed free (DFR), and total recall (DTR), and qualitative indices. This study provides psychometric properties, discriminative capacity, and diagnostic accuracy in older adults. A total of 136 older adults underwent a neuropsychological assessment and were classified as cognitively healthy (CH = 72) or as having MCI (N = 64). Partial correlations assessed internal, convergent, and discriminant validity, whereas ANCOVAs, logistic regressions, and Receiver Operating Characteristic (ROC) analysis evaluated diagnostic performance compared with the Montreal Cognitive Assessment (MoCA). IR and DTR scores showed associations with established neuropsychological measures, whereas DFR displayed a largely independent profile. After controlling for age and education, CH participants outperformed the MCI group on IR and DFR and showed higher Free Recall and Interference indices. Logistic regressions identified DFR as the strongest independent predictor of diagnostic status. ROC analyses demonstrated significant discrimination between groups for both DFR (AUC = 0.711) and the MoCA (AUC = 0.705), with no significant difference between the two ROC curves. While the MoCA showed higher sensitivity, DFR provided greater specificity, with an optimal cut-off of ≤ 3.21. These findings support the ItFNAT as a clinically useful measure of associative memory in aging. Particularly, DFR appears sensitive to early cognitive decline and may provide complementary information to standard cognitive tests.