Background: Most studies examining episodic memory in Alzheimer disease (AD) have focused on patients' impaired ability to remember information. This approach provides only a partial picture of memory deficits since other factors involved are not considered. Objective: To evaluate the recognition memory performance by using a yes/no procedure to examine the effect of discriminability and response bias measures in amnestic mild cognitive impairment (a-MCI), AD dementia, and normal-aging subjects. Methods: We included 43 controls and 45 a-MCI and 51 mild AD dementia patients. Based on the proportions of correct responses (hits) and false alarms from the Rey Auditory Verbal Learning Test (RAVLT), discriminability (d′) and response bias (C) indices from signal detection theory (SDT) were calculated. Results: Results showed significant group differences for d′ (F (2) = 83.26, p < 0.001), and C (F (2) = 6.05, p = 0.00). The best predictors of group membership were delayed recall and d′ scores. The d′ measure correctly classified subjects with 82.98% sensitivity and 91.11% specificity. Conclusions: a-MCI and AD dementia subjects exhibit less discrimination accuracy and more liberal response bias than controls. Furthermore, combined indices of delayed recall and discriminability from the RAVLT are effective in defining early AD. SDT may help enhance diagnostic specificity.

Boon ME, Melis RJ, Olde Rikkert MG, Kessels RP: Atrophy in the medial temporal lobe is specifically associated with encoding and storage of verbal information in MCI and Alzheimer patients. J Neurol Res 2011;1:11-15.
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E: Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999;56:303-308.
Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, Nordberg A, Bäckman L, Albert M, Almkvist O, Arai H, Basun H, Blennow K, de Leon M, DeCarli C, Erkinjuntti T, Giacobini E, Graff C, Hardy J, Jack C, Jorm A, Ritchie K, van Duijn C, Visser P, Petersen RC: Mild cognitive impairment - beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Int Med 2004;256:240-246.
Laakso MP, Hallikainen M, Hänninen T, Partanen K, Soininen H: Diagnosis of Alzheimer's disease: MRI of the hippocampus vs delayed recall. Neuropsychologia 2000;38:579-584.
Visser PJ, Scheltens P, Verhey FR, Schmand B, Launer LJ, Jolles J, Jonker C: Medial temporal lobe atrophy and memory dysfunction as predictors for dementia in subjects with mild cognitive impairment. J Neurol 1999;246:477-485.
Tounsi H, Deweer B, Ergis AM, Van der Linden M, Pillon B, Michon A, Dubois B: Sensitivity to semantic cuing: an index of episodic memory dysfunction in early Alzheimer disease. Alzheimer Dis Assoc Disord 1999;13:38-46.
Algarabel S, Fuentes M, Escudero J, Pitarque A, Peset V, Mazón JF, Meléndez JC: Recognition memory deficits in mild cognitive impairment. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2012;19:608-619.
Dubois B, Albert ML: Amnestic MCI or prodromal Alzheimer's disease? Lancet Neurol 2004;3:246-248.
Dubois B, Feldman HH, Jacova C, Dekosky ST, Barberger-Gateau P, Cummings J, Delacourte A, Galasko D, Gauthier S, Jicha G, Meguro K, O'Brien J, Pasquier F, Robert P, Rossor M, Salloway S, Stern Y, Visser PJ, Scheltens P: Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurol 2007;6:734-746.
Delis D, Massman P, Butters N, Salmon D, Cermak L, Kramer J: Profiles of demented and amnesic patients on the California Verbal Learning Test: implications for the assessment of memory disorders. Psychol Assessment 1991;3:19-26.
Libon DJ, Mattson RE, Glosser G, Kaplan E, Malamut BL, Sands LP, Swenson R, Cloud BS: A nine-word dementia version of the California Verbal Learning Test. Clin Neuropsychol 1996;10:237-244.
Donaldson W: Measuring recognition memory. J Exp Psychol Gen 1992;121:275-277.
Snodgrass JG, Corwin J: Pragmatics of measuring recognition memory: applications to dementia and amnesia. J Exp Psychol Gen 1988;117:34-50.
Bennett IJ, Golob EJ, Parker ES, Starr A: Memory evaluation in mild cognitive impairment using recall and recognition tests. J Clin Exp Neuropsychol 2006;28:1408-1422.
Woodard JL, Axelrod BN, Mordecai KL, Shannon KD: Value of signal detection theory indexes for Wechsler Memory Scale-III recognition measures. J Clin Exp Neuropsychol 2004;26:577-586.
Boone KB, Lu P, Wen J: Comparison of various RAVLT scores in the detection of noncredible memory performance. Arch Clin Neuropsychol 2005;20:301-319.
Peruzza Marchiani NC, Balthazar Figueredo ML, Cendes F, Pereira Damasceno B: Hippocampal atrophy and verbal episodic memory performance in amnestic mild cognitive impairment and mild Alzheimer's disease: a preliminary study. Dement Neuropsychol 2008;2:37-41.
Harris ME, Ivnik RJ, Smith GE: Mayo's Older Americans Normative Studies: expanded AVLT Recognition Trial norms for ages 57 to 98. J Clin Exp Neuropsychol 2002;24:214-220.
Tierney MC, Black SE, Szalai JP, Snow WG, Fisher RH, Nadon G, Chui HC: Recognition memory and verbal fluency differentiate probable Alzheimer disease from subcortical ischemic vascular dementia. Arch Neurol 2001;58:1654-1659.
Delis DC, Kramer JH, Kaplan E, Ober BA: California Verbal Learning Test-II, ed 2. San Antonio, The Psychological Corporation, 2000.
Budson AE, Wolk DA, Chong H, Waring JD: Episodic memory in Alzheimer's disease: separating response bias from discrimination. Neuropsychologia 2006;44:2222-2232.
Pooley J, Lee M, Shankle W: Recognition memory deficits in Alzheimer's disease: modeling clinical groups and individual patients. Proc 31st Annu Conf Cogn Sci Soc, Austin, 2009, pp 2849-2954.
Wixted JT: Dual-process theory and signal-detection theory of recognition memory. Psychol Rev 2007;114:152-176.
Corwin J: On measuring discrimination and response bias: unequal numbers of targets and distractors and two classes of distractors. Neuropsychology 1994;8:110-117.
Kramer JH, Rosen HJ, Du AT, Schuff N, Hollnagel C, Weiner MW, Miller BL, Delis DC: Dissociations in hippocampal and frontal contributions to episodic memory performance. Neuropsychology 2005;19:799-805.
Bartok JA, Wilson CS, Giordani B, Keys BA, Persad CC, Foster NL, Berent S: Varying patterns of verbal recall, recognition, and response bias with progression of Alzheimer's disease. Aging Neuropsychol Cogn 1997;4:266-272.
Shankle WR, Pooley JP, Steyvers M, Hara J, Mangrola T, Reisberg B, Lee MD: Relating memory to functional performance in normal aging to dementia using hierarchical Bayesian cognitive processing models. Alzheimer Dis Assoc Disord 2013;27:16-22.
Delis DC, Wetter SR, Jacobson MW, Peavy G, Hamilton J, Gongvatana A, Kramer JH, Bondi MW, Corey-Bloom J, Salmon DP: Recall discriminability: utility of a new CVLT-II measure in the differential diagnosis of dementia. J Int Neuropsychol Soc 2005;11:708-715.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4, Text Revision (DSM-IV-TR). Washington, American Psychiatric Association, 1994, vol 1, pp 943.
Allegri R, Ollari J, Mangone C, Arizaga R, De Pascale A, Pellegrini M: El ‘Mini-Mental State Examination' en la Argentina: instrucciones para su administración. Rev Neurol Argent 1999;24:31-35.
Folstein MF, Folstein SE, McHugh PR: ‘Mini mental state'. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
Morris JC: The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.
Petersen RC: Mild cognitive impairment as a diagnostic entity. J Int Med 2004;256:183-194.
Pfeffer RI, Kurosaki TT, Harrah CH, Chance JM, Filos S: Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.
Rey A: Psychological examination of traumatic encephalopathy. Arch Psychol 1941;28:286-340.
Rey A: L'examen clinique en psychologie. Paris, Presses Universitaires de France, 1964.
Wechsler D: WMS-R Wechsler Memory Scale - Revised Manual. New York, The Psychological Corporation, 1987.
Kaplan E, Goodglass H, Weintraub S: The Boston Naming Test. Philadelphia, Lea and Febiger, 1983.
Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G, Mellits ED, Clark C: The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology 1989;39:1159-1165.
Wechsler D: Wechsler Memory Scale, ed 3. San Antonio, The Psychological Corporation, 1997.
Reitan RM: Validity of the Trail Making Test as an indicator of organic brain damage. Percept Motor Skills 1958;8:271-276.
Dubois B, Slachevsky A, Litvan I, Pillon B: The FAB: a frontal assessment battery at bedside. Neurology 2000;55:1621-1626.
Yesavage JA, Sheikh JI: 9/Geriatric Depression Scale (GDS). Clin Gerontol 1986;5:165-173.
Kaufer DI, Cummings JL, Ketchel P, Smith V, MacMillan A, Shelley T, Lopez OL, DeKosky ST: Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. J Neuropsychiatry Clin Neurosci 2000;12:233-239.
Acevedo A, Krueger KR, Navarro E, Ortiz F, Manly JJ, Padilla-Vélez MM, Weintraub S, López OL, Mungas D: The Spanish translation and adaptation of the Uniform Data Set of the National Institute on Aging Alzheimer's Disease Centers. Alzheimer Dis Assoc Disord 2009;23:102-109.
Weintraub S, Salmon D, Mercaldo N, Ferris S, Graff-Radford NR, Chui H, Cummings J, DeCarli C, Foster NL, Galasko D, Peskind E, Dietrich W, Beekly DL, Kukull WA, Morris JC: The Alzheimer's Disease Centers' Uniform Data Set (UDS): the neuropsychologic test battery. Alzheimer Dis Assoc Disord 2009;23:91-101.
Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Moher D, Rennie D, de Vet HC, Lijmer JG: The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. The Standards for Reporting of Diagnostic Accuracy Group. Croat Med J 2003;44:639-650.
Beth EH, Budson AE, Waring JD, Ally BA: Response bias for picture recognition in patients with Alzheimer disease. Cogn Behav Neurol 2009;22:229-235.
Greenaway MC, Lacritz LH, Binegar D, Weiner MF, Lipton A, Munro Cullum C: Patterns of verbal memory performance in mild cognitive impairment, Alzheimer disease, and normal aging. Cogn Behav Neurol 2006;19:79-84.
Barbeau E, Didic M, Tramoni E, Felician O, Joubert S, Sontheimer A, Ceccaldi M, Poncet M: Evaluation of visual recognition memory in MCI patients. Neurology 2004;62:1317-1322.
Loewenstein DA, Acevedo A, Luis C, Crum T, Barker WW, Duara R: Semantic interference deficits and the detection of mild Alzheimer's disease and mild cognitive impairment without dementia. J Int Neuropsychol Soc 2004;10:91-100.
Libon DJ, Bondi MW, Price CC, Lamar M, Eppig J, Wambach DM, Nieves C, Delano-Wood L, Giovannetti T, Lippa C, Kabasakalian A, Cosentino S, Swenson R, Penney DL: Verbal serial list learning in mild cognitive impairment: a profile analysis of interference, forgetting, and errors. J Int Neuropsychol Soc 2011;17:905-914.
Buckner RL, Snyder AZ, Shannon BJ, LaRossa G, Sachs R, Fotenos AF, Sheline YI, Klunk WE, Mathis CA, Morris JC, Mintun MA: Molecular, structural, and functional characterization of Alzheimer's disease: evidence for a relationship between default activity, amyloid, and memory. J Neurosci 2005;25:7709-7717.
Baddeley AD, Bressi S, Della Sala S, Logie R, Spinnler H: The decline of working memory in Alzheimer's disease. A longitudinal study. Brain 1991;114:2521-2542.
Aggleton JP, Shaw C: Amnesia and recognition memory: a re-analysis of psychometric data. Neuropsychologia 1996;34:51-62.
Baxter MG, Murray EA: Opposite relationship of hippocampal and rhinal cortex damage to delayed nonmatching-to-sample deficits in monkeys. Hippocampus 2001;11:61-71.
Mayes AR, Roberts N: Theories of episodic memory. Philos Trans R Soc Lond B Biol Sci 2001;356:1395-1408.
Kopelman MD: Disorders of memory. Brain 2002;125:2152-2190.
Allegri RF, Russo MJ, Kremer J, Taragano FE, Brusco I, Ollari JA, Serrano CM, Sarasola D, Demey I, Arizaga RL, Bagnati P: Review of recommendations and new diagnosis criteria for mild cognitive impairment due to Alzheimer's disease. Vertex (Buenos Aires) 2012;23:5-15.
Butman J, Arizaga RL, Harris P, Drake M, Baumann D, de Pascale A, Allegri RF, Mangone CA, Ollari JA: El “Mini-Mental State Examination” en español. Normas para Buenos Aires. Rev Neurol Argent 2001;26:11-15.
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