Validity of Enhanced Cued Recall Test in the Dia­gnosis of Alzheimer Dementia and Behavioral Variant of Frontotemporal Dementia

Authors: M. Urbanová 1;  M. Vyhnálek 1,2;  T. Nikolai 1,2;  J. Michalec 3;  K. Sheardová 1,4;  J. Laczó 1,2;  D. Hudeček 1,4;  J. Hort 1,2
Authors‘ workplace: Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně 1;  Kognitivní centrum, Neurologická klinika 2. LF UK a FN v Motole, Praha 2;  Psychiatrická klinika 1. LF UK a VFN v Praze 3;  Neurologická klinika LF MU a FN u sv. Anny v Brně 4
Published in: Cesk Slov Neurol N 2014; 77/110(5): 576-581
Category: Original Paper

Za podpory projektu FNUSA‑ ICRC (no. CZ.1.05/ 1.1.00/ 02.0123) z Evropského fondu regionálního rozvoje, podpořeno MZ ČR –  RVO, FN v Motole 00064203 a grantem IGA NT 11225-4.


Enhanced Cued Recall (ECR) memory test is especially valuable in screening for cognitive impairment in the elderly. ECR uses categorical cues during controlled encoding and recall; tests based on this paradigm are considered to be able to identify hippocampal memory impairment characterized by poor free recall with minimal effect of cueing, typical of Alzheimer’s disease (AD). The test could aid in differentiating memory impairment in behavioural variant frontotemporal dementia (bvFTD) versus AD – despite the poor free recall bvFTD patients benefit considerably from cueing.

To establish the validity of ECR in diagnosing memory impairment in AD and bvFTD. Methods: Thirty six patients with probable mild AD (MMSE 21.7 ± 2.4), 15 with probable bvFTD (MMSE 23.8 ± 2.4) and 45 healthy elderly (HE) (MMSE 28.96 ± 1.17) underwent clinical and neuropsychological examination including ECR.

There was a statistically significant difference between all groups in all three ECR memory performance scores: free recall, total recall and cueing effect (p < 0.001). Free recall was the most effective score for discriminating dementias from healthy elderly (sensitivity 94% and specificity 100% for AD and sensitivity 80% and specificity 91% for bvFTD); total recall was most effective for differential diagnosis of both dementias (sensitivity 86% and specificity 87%).

ECR is a highly sensitive and specific test for identification of memory impairment in AD and bvFTD, and can contribute to the differential diagnosis. We recommend it as highly useful test for clinical practice.

Key words:
Alzheimer dementia – frontotemporal dementia – memory

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


1. Albert MS, Moss MB, Tanzi R, Jones K. Preclinical prediction of AD using neuropsychological tests. J Int Neuropsychol Soc 2001; 7(5): 631– 639.

2. Gregory CA, Hodges JR. Clinical features of frontal lobe dementia in comparison to Alzheimer’s disease. J Neural Transm 2006; 47: 103– 123.

3. Hutchinson AD, Mathias JL. Neuropsychological deficits in frontotemporal dementia and Alzheimer‘s disease: a meta‑analytic review. J Neurol Neurosurg Psychiatry 2007; 78(9): 917– 928.

4. Frisoni GB, Beltramello A, Geroldi C, Weiss C, Bianchetti A, Trabucchi M. Brain atrophy in fronto‑ temporal dementia. J Neurol Neurosurg Psychiatry 1996; 61(2): 157– 165.

5. Hirst W, Volpe BT. Memory strategies and brain damage. Brain Cogn 1988; 8(3): 379– 408.

6. Lezak MD, Howieson DB, Bigler ED, Tranel D. Neuropsychological assessment. New York: Oxford university press 2012.

7. Pasquier F, Grymonprez L, Lebert F, Van der Linden M. Memory impairment differs in frontotemporal dementia and Alzheimer‘s disease. Neurocase 2001; 7(2): 161– 171.

8. Carlesimo GA, Perri R, Caltagirone C. Category cued recall following controlled encoding as a neuropsychological tool in the dia­gnosis of Alzheimer‘s disease: a review of the evidence. Neuropsychol Rev 2011; 21(1): 54– 65. doi: 10.1007/ s11065‑ 010‑ 9153‑ 7.

9. Hort J, O’Brien JT, Gainotti G, Pirttila T, Popescu BO,Rektorova I et al. EFNS guidelines for the dia­gnosis and management of Alzheimer’s disease. Eur J Neurol 2010; 17: 1236– 1248. doi: 10.1111/ j.1468‑ 1331.2010.03040.x.

10. Grober E, Buschke H, Crystal H, Bang S, Dresner R.Screening for dementia by memory testing. Neurology 1988; 38(6): 900– 903.

11. Solomon PR, Pendlebury WW. Recognition of Alzheimer’s disease: the 7 Minute Screen. Fam Med 1998; 30(4): 265– 271.

12. Topinková E, Jirák R, Kožený J. Krátká neurokognitivní baterie pro screening demence v klinické praxi: Sedmiminutový screeningový test. Neurol Prax 2002; 3(6): 323– 328.

13. Dubois B, Albert ML. Amnestic MCI or prodromal Alzheimer’s disease? Lancet Neurol 2004; 3(4): 246– 248.

14. Thompson JC, Stopford LC, Snowden JS, Neary D. Qualitative neuropsychological performance characteristics in frontotemporal dementia and Alzheimer’s disease. J Neurol Neurosurg Psychiatry 2005; 76(7): 920– 927.

15. Saka E, Mihci E, Topcuoglu MA, Balkan S. Enhanced cued recall has a high utility as a screening test in the dia­gnosis of Alzheimer’s disease and mild cognitive impairment in Turkish people. Arch Clin Neuropsychol 2006; 21(7): 745– 751.

16. Saka E, Elibol B. Enhanced cued recall and clock drawing test performances differ in Parkinson’s and Alzheimer’s disease‑related cognitive dysfunction. Parkinsonism Relat Disord 2009; 15: 688– 691. doi: 10.1016/ j.parkreldis.2009.04.008.

17. 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(7): 939– 944.

18. Neary D, Snowden JS, Gustafson L, Passant U, Stuss D, Black S et al. Frontotemporal lobar degeneration: a consensus on clinical dia­gnostic criteria. Neurology 1998; 51(6): 1546– 1554.

19. Almeida OP, Almeida SA. Short versions of the geriatric depression scale: a study of their validity for the dia­gnosis of a major depressive episode according to ICD‑ 10 and DSM‑ IV. Int J Geriatr Psychiatry 1999; 14(10): 858– 865.

20. Dubois B, Feldman HH, Jacova C, Dekosky ST, Barberger‑ Gateau P, Cummings J et al. Research criteria for the dia­gnosis of Alzheimer’s disease: revising the NINCDS‑ ADRDA criteria. Lancet Neurol 2007; 6(8): 734– 746.

21. Vyhnalek M, Nikolai T, Andel R, Nedelska Z, Rubínová E, Marková H et al. Neuropsychological Correlates of Hippocampal Athrophy in Memory Testing in Nondemented Older Adults. J Alzheimers Dis 2014 [Epub ahead of print].

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 5

2014 Issue 5

Most read in this issue
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account