Utilization of the Denman Neuropsychology Memory Scale in the Classification of Patients with Mild Dementia of the Alzheimer-Type

Diagnosis of dementia of the A1zheimer-type (DAT) poses a serious challenge because the symptoms of the disease may vary widely, other reversible forms of dementia may mimic DAT, and only histopathological examination may confirm the presence of the disease. The incurability of the disease and the assumption that senility is a normal part of aging may add to dismissive approach to the disease. This paper outlines some of the historical perspectives which have led to the current conceptualization of dementia in general, and DAT specifically Major etiological hypotheses are reviewed. Some of the difficulties encountered in the clinical diagnosis of DAT are examined. A review of recent medical literature attests to professional awareness of inaccuracies and imprecision in diagnosing DAT and of the need for more comprehensive diagnostic evaluation. The literature is difficult to integrate however because of terminological confusion, the different levels of specificity at which the disease is discussed, and the fundamental ambiguity of the disease. A description of the clinical features of the disorder is presented. Previous attempts to characterize dementia by psychometric testing are reviewed. Finally, assessment of memory functioning is examined, with special consideration given to the need for greater diagnostic accuracy for mild or early stage DAT. It is the differentiation of the early stages of DAT and the normal aging process that is especially problematic. Although memory impairment is the earliest identifiable symptom of DAT, complaints of memory loss are common among the elderly in general. This study sought to address this diagnostic challenge by examining the capacity of a recently published memory scale, the Denman Neuropsychology Memory Scale, to contribute to the identification of early stage DAT. Twenty patients with mild dementia of the Alzheimer-type, diagnosed and staged by clinical research criteria, were compared to twenty control subjects matched for age, sex, and education. A profile of five subtests from the DNMS correctly classified 17 of 20 DAT patients and all of the healthy control subjects for an overall accuracy of 93\u27/.. It was concluded that the subtest profile could contribute to the differentiation of DAT from the normal aging process. Pending replication with a broader more normative sample, the identification of the profile obtained in the present study offers a tentative way to make the diagnosis of early DAT more reliable. Results are discussed with regard to the benefits that would accrue from improved methods of early detection of DAT