Screening for predementia AD Time-dependent operating characteristics of episodic memory tests

Objective: Data from the Einstein Aging Study (EAS) were used to prospectively evaluate the free recall score from the Free and Cued Selective Reminding Test (FCSRT-FR) and Logical Memory I immediate recall (LM-IR) subtest of the Wechsler Memory Scale-Revised for prediction of incident Alzheimer disease (AD) dementia among individuals from a community-based cohort with memory complaints. Methods: Analyses included 854 participants, age >= 70 years, who initially had no dementia, and had memory complaints. Clinic evaluations were completed annually and AD dementia was diagnosed using standard criteria (n = 86 cases; average follow-up 4.1 years). Time-dependent receiver operating characteristic analysis was used to evaluate the prognostic ability of FCSRT-FR and LM-IR for incident AD over various durations of follow-up. Results: For identifying those with memory complaints who will develop incident AD dementia over 2-4 years, the FCSRT-FR had better operating characteristics than LM-IR. APOE epsilon 4 status, age, and education did not affect cut points; however, positive predictive values were higher among APOE epsilon 4-positive individuals. Conclusions: For follow-up intervals of 2-4 years, the FCSRT-FR is more predictive than the LM-IR for identifying individuals with memory complaints who will develop incident AD. APOE epsilon 4 status improves positive predictive value, but does not affect the choice of optimal cuts. Neurology (R) 2013;80:1307-1314