A cognitive and ecological approach to neuropsychological assessment in Alzheimer's disease

The role of neuropsychology is central to the early diagnosis of AD, but the identification of the disease at this stage can be difficult for the specialist, as is the staging and tracking of the disease's progression. Early Alzheimer's disease has first to be differentiated from normal aging, and from other dementia types. From a neuropsychological point of view, recent studies have demonstrated that specific tests of episodic memory and executive functions increase the likelihood of identifying incident AD despite the heterogeneity of the disease. This can also be achieved by a combination of cognitive factors and other risk factors (such as subjective complaints, informant report, genetics, neuroimaging techniques). The cognitive approach to AD has also allowed the development of new rehabilitation strategies, which consist mainly of exploiting preserved abilities and performance enhancing factors. For example, the following three procedures could be used for the clinical management of memory problems in AD patients: (1) temporary facilitation of information encoding or retrieval by the use of optimizing factors revealed by detailed cognitive examinations; (2) new knowledge teaching by the use of preserved (implicit) memory abilities; (3) adaptation of the patient's environment with the help of external cues to compensate for impaired functions. Suggestions are put forward in regard to the assessment of both neuropsychological and pharmacological treatment effect.