Yes/No Versus Forced-Choice Recognition Memory in Mild Cognitive Impairment and Alzheimer's Disease: Patterns of Impairment and Associations with Dementia Severity

Abstract

Memory tests are sensitive to early identification of Alzheimer's disease (AD) but less useful as the disease advances. However, assessing particular types of recognition memory may better characterize dementia severity in later stages of AD. We sought to examine patterns of recognition memory deficits in individuals with AD and mild cognitive impairment (MCI). Memory performance and global cognition data were collected from participants with AD (n = 37), MCI (n = 37), and cognitively intact older adults (normal controls, NC; n = 35). One-way analyses of variance (ANOVAs) examined differences between groups on yes/no and forced-choice recognition measures. Individuals with amnestic MCI performed worse than NC and nonamnestic MCI participants on yes/no recognition, but were comparable on forced-choice recognition. AD patients were more impaired across yes/no and forced-choice recognition tasks. Individuals with mild AD (≥120 Dementia Rating Scale, DRS) performed better than those with moderate-to-severe AD (<120 DRS) on forced-choice recognition, but were equally impaired on yes/no recognition. There were differences in the relationships between learning, recall, and recognition performance across groups. Although yes/no recognition testing may be sensitive to MCI, forced-choice procedures may provide utility in assessing severity of anterograde amnesia in later stages of AD. Implications for assessment of insufficient effort and malingering are also discussed.

Keywords:

• Recognition memory
• Alzheimer's disease
• Mild cognitive impairment
• Dementia severity
• Neuropsychology

Acknowledgements

This work was supported by Alzheimer's Association Grants IIRG 07-59343 (M.B.) and National Institute on Aging Grants R01 AG012674 (M.B.), K24 AG026431 (M.B.), and P50 AG05131 (D.S.). Dean Delis has a financial interest in one of the neuropsychological measures administered as part of this study. He is the lead author of the California Verbal Learning Test II, published by Pearson. There are no other financial or additional conflicts of interest pertaining to this manuscript. The authors gratefully acknowledge the assistance of Gali Weissberger, Jason Gravano, and Ashley McCauley for their assistance in data collection as well as the staff, patients, and volunteers of the University of California San Diego Alzheimer's Disease Research Center (UCSD ADRC).