The utility of neuropsychological process scores in verbal recall and verbal fluency in persons with or at risk for dementia: Data from COMPASS‐ND

Background Subjective cognitive decline (SCD) is considered a risk state for decline to mild cognitive impairment (MCI) or dementia due to Alzheimer’s disease (AD). By definition, individuals with SCD report concerns about changes in cognitive function but perform within normal limits on formal testing. This study examined whether neuropsychology process scores on tests of auditory learning and memory (the Rey Auditory Verbal Learning Test, RAVLT) and semantic and phonemic oral fluency were able to distinguish subtle difficulties in cognition, over and above total scores. Method We used data from the Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS‐ND) study to examine performance in 60 cognitively normal (CN) older adults with no cognitive complaints (mean age = 69 years; mean education = 16 years), 55 participants with SCD (age = 70; education = 17), 102 with MCI (age = 72; education = 16), and 47 with AD (age = 75; education = 15). Participants were matched on age and education, except for AD participants who were older. Age and education were co‐variates in all analyses. For the RAVLT, we examined delayed recall total scores, and process measures of primacy and recency recall on the second learning trial. For fluency, we examined total scores, and process measures of clustering, switching, word frequency, and age of acquisition. Result RAVLT: An item position by group interaction revealed that primacy scores better distinguished all participant groups (CU>SCD>MCI>AD) than delayed recall (CU = SCD = MCI>AD). The left subiculum hippocampal subfield volume was positively associated with primacy scores in the MCI group, controlling for intracranial volume and age. Oral fluency: Both phonemic and semantic total scores discriminated CN, MCI, and AD participants in a stepwise manner; there was a non‐significant trend for SCD participants to perform more poorly than CN. Process scores did not provide additional discrimination. Conclusion These findings indicate that primacy scores for episodic recall are sensitive to subtle memory deficits in SCD and may reflect hippocampal atrophy, supporting the clinical use of using serial position effects in the assessment of MCI and SCD. Learning Objective(s): Participants will learn about more detailed scoring methods for common neuropsychological tests, their sensitivity to subtle cognitive deficits in SCD, and their relationship with neuroanatomical structures.