JAGS 51:32–37, 2003 © 2003 by the American Geriatrics Society 0002-8614/03/$15.00 Amnestic Behavior in Dementia: Symptoms to Assist in Early Detection and Diagnosis Rebecca E. Ready, PhD,* Brian R. Ott, MD, † and Janet Grace, PhD* OBJECTIVES: This study evaluated two amnestic behav- ior changes (repetitive questioning and repetitive actions) to determine their utility in screening for early dementia. DESIGN: Patient data were collected through a retrospec- tive chart review. Comparison data from nondemented older people were collected prospectively from acquain- tances of clinic patients. SETTING: The setting was a hospital-based outpatient memory disorder clinic. PARTICIPANTS: Participants were older individuals with no cognitive impairment (n = 25), undetermined de- mentia (n = 50), and definite dementia (n = 25). The un- determined cases were followed for at least 1 year to assess for conversion to dementia. MEASUREMENTS: Amnestic behaviors were assessed using informant-report for all participants. The behaviors were examined for their ability to distinguish between def- inite dementia cases and noncases. They were further eval- uated for the ability to differentiate undetermined cases that eventually converted to definite dementia from cases that did not convert. RESULTS: Results indicated that repetitive behaviors were common in early and more-severe dementia cases. Repeti- tive behaviors were relatively uncommon in cognitively in- tact older participants. In analyses of the full study sample, engagement in repetitive behaviors had high sensitivity (0.97) in identifying dementia cases. CONCLUSIONS: Assessing repetitive behaviors in pa- tients may be a useful means for family members and pri- mary care physicians to screen for early cognitive impair- ment. The assessment can help to identify individuals that should be evaluated further for dementia. J Am Geriatr Soc 51:32–37, 2003. Key words: dementia; mild cognitive impairment; screen- ing test; amnestic behaviors; repetitive behavior arly detection of dementia is critical as new therapies are developed to alter the course of neurodegenerative disease. 1 The American Academy of Neurology (AAN) re- cently published guidelines to assist in the early detection of Alzheimer’s disease (AD) by physicians. 2 The Alzheimer’s Association also recently developed a list of warning signs to assist patients and their families in determining when to seek a complete dementia evaluation by a physician. 3 Included in guidelines for early detection of dementia are changes in behavior. Behavior change is a common consequence of neurodegenerative disease, 4,5 but specific types of behavior changes are not well characterized. Bet- ter identification of behavior changes associated with memory loss that occur in early dementia would assist family members in deciding when to bring a patient to a physician for an examination. Primary care physicians also would be assisted in identifying which patients should be given a comprehensive evaluation for dementia, includ- ing laboratory tests, neuroimaging, and neuropsychologi- cal testing. Data indicate that a neuropsychological battery of tests exhibits excellent sensitivity and specificity in diag- nosing dementia, 2 but they are too lengthy and time con- suming to administer to all patients. Thus, primary care physicians need a screening test to better identify individu- als at risk for dementia to whom current diagnostic tests can be selectively administered. 6 Screening tests are simple, cost-effective tests intended to identify patients who may have a disease and thus should have high sensitivity. 1,7 Di- agnostic tests are often lengthier and more costly tests that are applied to individuals who screen positive on a screen- ing test and are used to establish a diagnosis. Questions about behavior change have not been eval- uated as screens for early dementia. In contrast, several cognitive screening tests for dementia have been evaluated. For example, the clock-drawing test (CDT) has been found to be a quick and easy measure that is useful as a screening instrument in the detection of early dementia. 8,9 From the *Departments of Psychiatry and Human Behavior, and † Clinical Neurosciences, Brown University School of Medicine, Pawtucket, Rhode Island. The project was supported by National Institutes of Health, National Institute of Aging postdoctoral Fellowship 1F32AG20008-01 to RER. Address correspondence to Rebecca E. Ready, PhD, Memorial Hospital of Rhode Island, Medical Rehabilitation Department, 11 Brewster Street, Pawtucket, RI 02860. E-mail: Rebecca_Ready@mhri.org E