(E)Table 1. Key findings from the initial evaluation of the very mildly impaired patients who were inaccurately diagnosed with Alzheimer’s Disease
or one of its variants. The initial clinical diagnosis (DX) and the final diagnosis are also shown.
Insidious Onset/ Pertinent History Neurological Examination Hachinski Neuroimaging Depression Clinical DX Final DX (Clinical
Gradual Decline Score (DIS) or Autopsy)
(Rosen)
Autopsy
Diagnosis
Patient # 1 Yes None Extrapyramidal Features 2 MRI: Generalized No Probable LBV Dementia with
Atrophy and Deep Argyrophilic Grains
White Matter Changes
Patient # 2 Yes None Extrapyramidal Features 2 CT: Volume Loss No Probable LBV Progressive
Limitation of Vertical Gaze Supranuclear Palsy
Abnormal Coordination
Gait Disorder
Lower Motor Neuron Weakness
Patient # 3 Yes None Extrapyramidal Features 2 CT: Normal Yes Probable LBV Vascular Dementia
Limitation of Vertical Gaze (2 yrs. Before
Abnormal Coordination ADRC Evaluation)
Gait Disorder
Other Clinical
Diagnosis
Patient # 4 Yes Seizure Disorder, Normal 0 CT and MRI: Normal Yes Possible AD Traumatic Dementia
Two Motor Vehicle
Accidents with Loss
of Consciousness
(E)Table 1 (Continued)
Insidious Onset/ Pertinent History Neurological Examination Hachinski Neuroimaging Depression Clinical DX Final DX (Clinical
Gradual Decline Score (DIS) or Autopsy)
(Rosen)
Other Clinical
Diagnosis
(Continued)
Patient # 5 Yes Family History of Normal 0 None No Possible AD Familial
Striato-Nigral Striato-Nigral
Degeneration Degeneration
Patient # 6 Yes None Normal 0 CT: Generalized No Probable AD Amnestic Disorder
Atrophy
Patient # 7 Yes Alcohol Abuse Extrapyramidal Features 5 MRI: Generalized No Probable AD Probable Progressive
Hypothyroidism Limitation of Vertical Gaze Atrophy Supranuclear Palsy
Abnormal Coordination
Gait Disorder
Normal
Patient # 8 Yes None Normal 0 CT: Small Left Yes Possible AD Normal
Fronto-Parietal
Hyperintensity (Poss.
Meningioma)
Patient # 9 Yes Cardiovascular Normal 0 CT: Normal No Probable AD Normal
Disease
Patient # 10 Yes None Normal 2 CT: Generalized No Probable AD Normal
Atrophy (Later Treated)
Patient # 11 Yes None Extrapyramidal Features 1 None No Probable AD Normal
Patient # 12 Yes Hypothyroidism Normal 1 None No Possible AD Normal
(E)Table 2. The mean score achieved by the normal control (NC) subjects and very mildly impaired
patients with Alzheimer’s Disease (AD) on the neuropsychological test measures at the initial
evaluation. Standard deviations are shown in parentheses.
Neuropsychological Test NC Subjects AD Patients
(n=98) (n=98)
Global Mental Status
Dementia Rating Scale (Max.=144; n=74) 137.7 (5.7) 120.0 (9.6)
Attention
WAIS-R Digit Span Subtest (Max.=19; n=93) 10.0 (2.7) 8.4 (2.0)
(Scale Score)
Memory
BSRT-Trial 6 Total (Max.=10; n=75) 8.1 (1.7) 4.5 (1.4)
BSRT-Trial 6 LTM (Max.=10; n=75) 7.0 (2.6) 1.8 (1.6)
CVLT-Trials 1-5 (T-score) (Avg.=100; n=23) 46.7 (13.3) 22.1 (11.0)
CVLT-Short Delay (z-score; n=20) -0.4 (1.4) -2.6 (1.0)
CVLT-Long Delay (z-score; n=20) -0.4 (1.3) -2.7 (0.9)
Visual Reproduction Test (Max.=21; n=82) 12.0 (4.1) 6.5 (3.4)
(Immediate)
Visual Reproduction Test (Max.=21; n=82) 8.9 (4.1) 1.6 (2.5)
(Delay)
Logical Memory Test (Max.=50; n=27) 24.6 (6.9) 11.1 (5.8)
(Immediate)
Logical Memory Test (Max.=50; n=27) 18.0 (7.5) 3.6 (4.7)
(Delay)
Language
Boston Naming Test (Max.=30; n=95) 27.5 (2.3) 22.5 (5.2)
Letter Fluency Test (FAS) (n=95) 40.8 (12.1) 28.0 (11.3)
Category Fluency Test (n=95) 46.8 (8.8) 25.7 (8.5)
(Animals, Fruits, Vegetables)
WAIS-R Vocabulary Subtest (Max.=19; n=92) 12.2 (2.8) 10.2 (2.7)
(Scale Score)
(E)Table 2 (Continued)
Neuropsychological Test NC Subjects AD Patients
(n=98) (n=98)
Executive Functions
Modified WCST- Categories (Max.=6; n=90) 5.3 (1.3) 3.2 (1.8)
Modified WCST-(n=90) 2.0 (5.1) 10.2 (12.2)
Perseverations
Trail Making Test-Part A (Max.=150; n=93) 48.5 (20.8) 85.0 (56.7)
Trail Making Test-Part B (Max.=300; n=87) 103.1 (47.5) 213.0 (75.4)
WAIS-R Similarities Subtest (Max.=19; n=76) 10.8 (2.3) 8.0 (2.8)
(Scale Score)
WAIS-R Digit-Symbol (Max.=19; n=89) 6.9 (1.8) 4.1 (1.7)
Substitution Test
(Scale Score)
WAIS-R Arithmetic Subtest (Max.=19; n=76) 10.9 (3.2) 7.3 (2.3)
(Scale Score)
Constructional and
Visuospatial Ability
WISC-R Block Design (Max.=62; n=94) 41.8 (10.4) 23.2 (14.1)
Subtest
(Raw Score)
Clock Drawing Test-(Max.=3; n=95) 2.7 (0.6) 2.2 (0.8)
Command
Clock Drawing Test-Copy (Max.=3; n=95) 2.9 (0.3) 2.6 (0.7)
Copy-a-Cube Test (Max.=13; n=89) 12.0 (1.2) 10.5 (2.9)
Visual Reproduction Test (Max.=21; n=82) 17.4 (2.4) 15.8 (3.6)
(Copy)
WAIS-R=Wechsler Adult Intelligence Scale-Revised; BSRT=Buschke Selective Reminding Test;
CVLT=California Verbal Learning Test; WCST=Wisconsin Card Sorting Test; WISC-R=Wechsler
Intelligence Scale for Children-Revised; Max.=Maximum score; n=the number of matched pairs of
normal control subjects and patients with Alzheimer disease that completed the test.
(E)Figure Legends:
(E)Figure 1. Receiver Operating Characteristic (ROC) curves comparing sensitivity and specificity for the accurate diagnosis of Alzheimer’s disease (AD) achieved with the Dementia Rating Scale, the Long-Delay Free Recall measure from the California Verbal Learning Test (CVLT), the Delayed Recall measure from the Logical Memory Test, and the Delayed Recall measure from the Visual Reproduction Test. The maximally effective cutpoint for each test is also shown.
(E)Figure 2. Receiver Operating Characteristic (ROC) curves comparing sensitivity and specificity for the accurate diagnosis of Alzheimer’s disease (AD) achieved with the Trial 1-5 Learning
measure from the California Verbal Learning Test (CVLT), the Category Fluency Test, Part B of the Trail-Making Test, and the Block Design Test. The maximally effective cutpoint for each test is also shown.
100100
9090
8080
7070
6060
100100
5050
Cutpoint: < -1.5Cutpoint: < 133
9090
4040
Sensitivity = 98% Sensitivity = 96%8080CVLT Long-Delay Free Recall (Z-Score)Dementia Rating Scale
3030Specificity = 88%Specificity = 92%7070
2020
6060
1010Sensitivity (%)Sensitivity (%)
5050
00
010203040506070809010001020304050607080901004040
Visual Reproduction Test: Delayed RecallLogical Memory Test: Delayed Recall
3030
2020
1010Sensitivity (%)Sensitivity (%)
00
01020304050607080901000102030405060708090100
Specificity (%)Specificity (%)
Cutpoint: < 4Cutpoint: < 10
Sensitivity = 87%Sensitivity = 87%
Specificity (%)Specificity (%)
Specificity = 86%Specificity = 89%
100100
9090
8080
7070
6060
100100
5050
Cutpoint: < 389090Cutpoint: < 36
4040
8080Sensitivity = 96% Sensitivity = 95%
Specificity = 88%Specificity = 89%Category Fluency TestCVLT Trials 1-5 (T-Score)3030
7070
2020
6060
1010Sensitivity (%)Sensitivity (%)5050
Cutpoint: < 34Cutpoint: > 130
00
010203040506070809010001020304050607080901004040
Sensitivity = 78%Sensitivity = 85%
Trail-Making Test: Part BSpecificity = 79%Block Design Test (WISC-R)3030Specificity = 83%2020
1010Sensitivity (%)Sensitivity (%)
00
01020304050607080901000102030405060708090100
Specificity (%)Specificity (%)
Specificity (%)Specificity (%)