A Novel Cognitive Stress Test for the Detection of Preclinical Alzheimer Disease: Discriminative Properties and Relation to Amyloid Load

David A. Loewenstein, Rosie E. Curiel, Maria T. Greig, Russell M. Bauer, Marian Rosado, Dawn Bowers, Meredith Wicklund, Elizabeth Crocco, Michael Pontecorvo, Abhinay D. Joshi, Rosemarie Rodriguez, Warren W. Barker, Jacqueline Hidalgo, Ranjan Duara

Research output: Contribution to journalArticlepeer-review

52 Scopus citations


Objective To examine the utility of a novel “cognitive stress test” to detect subtle cognitive impairments and amyloid load within the brains of neuropsychologically normal community-dwelling elders. Methods Participants diagnosed as cognitively normal (CN), subjective memory impairment (SMI), mild cognitive impairment (MCI), and preclinical mild cognitive impairment (PreMCI) were administered the Loewenstein-Acevedo Scale for Semantic Interference and Learning (LASSI-L), a sensitive test of proactive semantic interference (PSI), retroactive semantic interference, and, uniquely, the ability to recover from the effects of PSI. Ninety-three subjects (31 men and 62 women) were recruited from three academic institutions in a research consortium. A subset of these individuals underwent 18F florbetapir positron emission tomography scanning. Relative percentages of impairment for each diagnostic group on the LASSI-L were calculated by χ2 and Fisher's exact tests. Spearman's rho was used to examine associations between amyloid load and different cognitive measures. Results LASSI-L deficits were identified among 89% of those with MCI, 47% with PreMCI, 33% with SMI, and 13% classified as CN. CN subjects had no difficulties with recovery from PSI, whereas SMI, preMCI, and MCI participants evidenced deficits in recovery from PSI effects. Among a subgroup of participants with normal scores on traditional neuropsychological tests, the strong associations were between the failure to recover from the effects of PSI and amyloid load in the brain. Conclusion Failure to recover or compensate for the effects of PSI on the LASSI-L distinguishes the LASSI-L from other widely used neuropsychological tests and appears to be sensitive to subtle cognitive impairments and increasing amyloid load.

Original languageEnglish (US)
Pages (from-to)804-813
Number of pages10
JournalAmerican Journal of Geriatric Psychiatry
Issue number10
StatePublished - Oct 1 2016


  • MCI
  • PreMCI
  • amyloid
  • proactive interference recovery

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health


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