Annals of Long-Term Care: Clinical Care and Aging. 2016;24(2):39.
A new study published in the Journal of Alzheimer’s Disease reveals a new clue to understanding misdiagnoses of Alzheimer’s disease, reporting that older adults with a history of reading problems perform similarly on some neuropsychological tests to those exhibiting signs of mild cognitive impairment (MCI) associated with early Alzheimer’s disease.
The finding, reported by a Stony Brook University-led research team in collaboration with Boston University School of Medicine, emphasizes the need for professionals to take into account developmental history and have a broad understanding of neuropsychological testing when interpreting the meaning of low memory test scores.
Lead author Brian K Lebowitz, PhD (Stony Brook University Medical Center, Stony Brook, NY, and Harvard Medical School, Boston, MA), and colleagues assessed the relationship between MCI classification and suspected reading disorder in 1804 community living adults (mean age, 62 years) in the Framingham Heart Study from 1999 to 2005. Individuals with previous dementia, stroke and other neurological disorders were excluded from the study.
Memory recall, reading, visual processing, and executive functioning were measured using tests frequently employed in the assessment of cognitive complaints in older adults. Specific areas of memory analyzed included recall of previously presented short stories and word pairs, and the ability to draw from memory previously presented visual figures. “We found a strong relationship between poor reading ability and low memory test scores,” said Dr Lebowitz.
Because memory complaints are extremely common in older adults, a lot of weight is placed on memory test scores when assessing the clinical significance of a patient’s memory concerns. However, memory tests are often administered alone, without a comprehensive battery of neuropsychological tests that include testing for reading ability, and without a clear understanding of a patient’s lifelong pattern of cognitive strengths and weaknesses.
“Identifying the clinical significance of our finding is our next challenge,” Dr Lebowitz said. “It could mean that a reading or learning disorder history may increase the misdiagnosis of neurodegenerative disease, including Alzheimer’s disease. Alternatively, a reading disorder may represent a risk factor for the development of Alzheimer’s disease in later life.”
Dr Lebowitz and colleagues emphasize that the findings highlight the need for professionals who evaluate the cognitive abilities of older adults to consider the individual’s history and alternative reasons why memory test scores may be low.—Amanda Del Signore