Preserved cognitive skills in dementia of the Alzheimer type
W. W. Beatty, P. Winn, R. L. Adams, E. W. Allen, D. A. Wilson, J. R. Prince, K. A. Olson, K. Dean and D. Littleford
Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City.
OBJECTIVE: To describe preserved cognitive skills in patients with
dementia. DESIGN: Case series. SETTING: Community clinic. PATIENTS: Five
patients who met National Institute of Neurological and Communicative
Disorders and Stroke-Alzheimer's Disease and Related Disorders Association
criteria for probable Alzheimer's disease and were claimed to retain a
cognitive skill. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Standard
neuropsychological tests and individualized measures of patient's skilled
behaviors. For patients who remained skilled at games, performance was
compared with that of normal controls in direct competition. For the
patient-trombonist, raters compared premorbid and postmorbid recordings of
his play. RESULTS: One patient continued to play the trombone in a
Dixieland band, although he could not name well-known numbers that he
played. Another continued to solve adult jigsaw puzzles. A third patient
retained skill at canasta, the fourth at dominoes. The fifth patient
remained a skillful contract bridge player, although he could not name the
suits or articulate simple bidding rules. Four patients had impaired
performance on standard anterograde and remote memory and naming tests but
performed normally on pursuit rotor and letter fluency tests. Mini-Mental
State Examination scores for these patients ranged from 10 to 22. One
patient refused neuropsychological testing but displayed his skill.
CONCLUSIONS: Together with previous studies of preserved piano playing or
painting skills, our findings indicate that a broad range of complex
cognitive abilities may be preserved in patients with dementia of the
Alzheimer type who cannot perform simpler actions.
