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Mary C. Tierney, PhD; Sandra E. Black, MD; John P. Szalai, PhD; W. Gary Snow, PhD; Rory H. Fisher, MB; Grant Nadon, MD; Helena C. Chui, MD

Arch Neurol. 2001;58:1654-1659.

Background  Alzheimer disease (AD) and vascular dementia are among the most frequently occurring causes of dementia in the world, and their accurate differentiation is important because different pharmaceutical strategies may modify the course of each disease.

Objective  To determine which of 10 neuropsychological test scores can accurately differentiate patients with probable AD from those with subcortical ischemic vascular dementia (SIVD) for use in evidence-based clinical practice.

Design  Patients with suspected dementia were referred to the study by family physicians, geriatricians, and neurologists. All participants received a thorough assessment according to standard diagnostic guidelines. Diagnoses of probable AD (n = 31) and probable SIVD (n = 31) were made according to consensus criteria. The diagnosticians were blind to the results of the 10 neuropsychological test scores.

Results  There were no significant differences between the groups in age or Mini-Mental State Examination scores. Logistic regression analyses identified 2 neuropsychological tests that best distinguished the groups (sensitivity = 81%; specificity = 84%; positive likelihood ratio = 5.1). These were the recognition memory subtest of the Rey Auditory Verbal Learning Test and the Controlled Oral Word Association Test. The AD group performed better on the oral association test, whereas the SIVD group did better on the recognition memory test.

Conclusion  Patients with probable AD and probable SIVD can be distinguished with a high degree of accuracy using these 2 neuropsychological tests.

From Geriatric Research (Drs Tierney and Snow) and the Department of Family and Community Medicine (Dr Tierney), the Department of Medicine (Neurology) (Dr Black), Clinical Epidemiology and Health Services Research (Dr Szalai), and the Department of Medicine (Geriatric Medicine) (Drs Fisher and Nadon), Sunnybrook and Women's College Health Sciences Center, University of Toronto, Toronto, Ontario; and the Department of Neurology (Dr Chui), University of Southern California, Los Angeles.

Corresponding author and reprints: Mary C. Tierney, Geriatric Research, A145, Sunnybrook and Women's Health Sciences Center, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5 (e-mail: mary.tierney{at}swchsc.on.ca).

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