The rigorous diagnosis of dementia, especially in the early stages, requires clinical observation and neuropsychological tests. This article shows how a short strategy-oriented neuropsychological battery, the Cognitive Efficiency Profile (CEP), can contribute to the early diagnosis of Alheimer's disease.
The CEP was given to 56 subjects who had been independently diagnosed as being cognitively unimpaired (N = 16), as having probable AD with mild dementia ( N = 32) or as having 'borderline' deterioration ( N = 8). One-year follow-up showed that all the latter patients developed unequivocal dementia. There was a clear-cut separation in the test results between the controls and the probable AD cases when the scores were corrected for age and education. There was some overlap between the borderline cases and the probable AD patients but, in all cases, the corrected scores fell below those of normal controls.
The usefulness of the CEP rests on the fact that it assesses the efficiency or the failure of strategies applied to a number of abilities related to cognitive efficiency. Coupled with clinical data, a good or a poor performance on the CEP strongly corroborates the diagnosis of normal cognitive functioning or of dementia in the elderly. KEY woms-Dementia, Alzheimer's disease, neuropsychological tests, diagnosis.
Despite recent advances in the field, the clinical diagnosis of dementia in the elderly is associated with many problems and remains difficult. Several publications have dealt with the problem of dementia from a diagnostic standpoint. The publication of DSM-I11 and DSM-111-R by the American Psychiatric Association (APA, 1980(APA, , 1987) ) as well as the NINCDWADRDA (McKhann et aZ., 1984) criteria for Alzheimer's disease (AD) represent recent examples aimed at defining a set of rules to diagnose those syndromes in an objective fashion.
Most clinicians in the field agree that the rigorous diagnosis of dementia, especially in the early stages, requires both clinical observations and the results of formal neuropsychological tests. A high degree of validity has been demonstrated for the clinical rules (Forette et aZ., 1989) as well as for the rules based on detailed neuropsychological tests (Huff et al., 1987).