Differentiating between Alzheimer’s Disease and Vascular Cognitive Impairment: Is the “Memory Versus Executive Function” Contrast Still Relevant?
Article type: Research Article
Authors: Andriuta, Daniela; * | Roussel, Martine | Barbay, Mélanie | Despretz-Wannepain, Sandrine | Godefroy, Olivier | Godefroy and GRECogVASC study group
Collaborators: Godefroy, Olivier | Roussel, Martine | Barbay, Mélanie | Canaple, Sandrine | Lamy, Chantal | Leclercq, Claire | Arnoux, Audrey | Despretz-Wannepain, Sandrine | Despretz, Pascal | Berrissoul, Hassan | Picard, Carl | Diouf, Momar | Loas, Gwénolé | Deramond, Hervé | Taillia, Hervé | Ardisson, Anne-Emmanuelle | Nédélec-Ciceri, Claudine | Bonnin, Camille | Thomas-Anterion, Catherine | Grangette, Francoise | Varvat, Jérome | Quaglino, Véronique | Beaunieux, Hélène | Moroni, Christine | Martens-Chazelles, Audrey | Batier-Monperrus, Stéphanie | Monteleone, Cécile | Costantino, Véronique | Theunssens, Eric
Affiliations: Department of Neurology and Laboratory of Functional Neurosciences, Amiens University Hospital, France | Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France | Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France | Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France | Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France | Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France | Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France | Department of Neurology, University Hospital of Amiens, France | University of Lille, INSERM CIC-IT 807, France | University Hospital of Amiens, France | Department of Biostatistics and medical research, University Hospital of Amiens, France | Department of Biostatistics and medical research, University Hospital of Amiens, France | Department of Psychiatry and Laboratory of Functional Neurosciences, University Hospital of Amiens, France | Department of Radiology, University Hospital of Amiens, France | Department of Neurology, Val de Grace Hospital, Paris, France | Department of Neurology, Val de Grace Hospital, Paris, France | Department of Neurology, Hospital of La Rochelle, France | Department of Neurology, Hospital of La Rochelle, France | Department of Neurology, University Hospital of St Etienne, France | Department of Neurology, University Hospital of St Etienne, France | Department of Neurology, University Hospital of St Etienne, France | Department of Psychology and Laboratory CRPPCO, University of Amiens, France | Department of Psychology, University of Caen, France | Department of Psychology, University of Lille, France | Department of Neurology, Hospital of Creil, France | Department of Neurology, Hospital of Epinal, France | Department of Neurology, Hospital of Ajaccio, France | Department of Neurology, Hospital of Ajaccio, France | Department of Speech Therapy, Haute Ecole de Liège, Belgium | Department of Neurology and Laboratory of Functional Neurosciences, Amiens University Hospital, France | Department of Neurology and Laboratory of Functional Neurosciences, Amiens University Hospital, France | Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France | Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France | Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France | Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France | Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France | Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France | Department of Neurology, University Hospital of Amiens, France | University of Lille, INSERM CIC-IT 807, France | University Hospital of Amiens, France | Department of Biostatistics and medical research, University Hospital of Amiens, France | Department of Biostatistics and medical research, University Hospital of Amiens, France | Department of Psychiatry and Laboratory of Functional Neurosciences, University Hospital of Amiens, France | Department of Radiology, University Hospital of Amiens, France | Department of Neurology, Val de Grace Hospital, Paris, France | Department of Neurology, Val de Grace Hospital, Paris, France | Department of Neurology, Hospital of La Rochelle, France | Department of Neurology, Hospital of La Rochelle, France | Department of Neurology, University Hospital of St Etienne, France | Department of Neurology, University Hospital of St Etienne, France | Department of Neurology, University Hospital of St Etienne, France | Department of Psychology and Laboratory CRPPCO, University of Amiens, France | Department of Psychology, University of Caen, France | Department of Psychology, University of Lille, France | Department of Neurology, Hospital of Creil, France | Department of Neurology, Hospital of Epinal, France | Department of Neurology, Hospital of Ajaccio, France | Department of Neurology, Hospital of Ajaccio, France | Department of Speech Therapy, Haute Ecole de Liège, Belgium
Correspondence: [*] Correspondence to: Daniela Andriuta, MD, Department of Neurology, Amiens University Hospital, F-80054 Amiens, France. Tel.: +33 322 668 240; Fax: +33 322 668 240; E-mail: [email protected].
Abstract: Background:The contrast between memory versus executive function impairments is commonly used to differentiate between neurocognitive disorders (NCDs) due to Alzheimer’s disease (AD) and vascular cognitive impairment (VCI). We reconsidered this question because of the current use of AD biomarkers and the recent revision of the criteria for AD, VCI, and dysexecutive syndrome. Objective:To establish and compare the neuropsychological profiles in AD (i.e., with positive CSF biomarkers) and in VCI. Methods:We included 62 patients with mild or major NCDs due to pure AD (with positive CSF biomarker assays), and 174 patients (from the GRECogVASC cohort) with pure VCI. The neuropsychological profiles were compared after stratification for disease severity (mild or major NCD). We defined a memory-executive function index (the mean z score for the third free recall and the delayed free recall in the Free and Cued Selective Reminding Test minus the mean z score for category fluency and the completion time in the Trail Making Test part B) and determined its diagnostic accuracy.Results: Compared with VCI patients, patients with AD had significantly greater memory impairments (p = 0.001). Executive function was impaired to a similar extent in the two groups (p = 0.11). Behavioral executive disorders were more prominent in the AD group (p = 0.001). Although the two groups differed significant with regard to the memory-executive function index (p < 0.001), the latter’s diagnostic accuracy was only moderate (sensitivity: 63%, specificity: 87%). Conclusion:Although the contrast between memory and executive function impairments was supported at the group level it does not reliably discriminate between AD and VCI at the individual level.
Keywords: Alzheimer’s disease, dysexecutive syndrome, memory, vascular cognitive impairment
DOI: 10.3233/JAD-171097
Journal: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 625-633, 2018
