Rosa Gonzalez, a sixty-four-year-old woman from the Dominican Republic, was brought by her daughter into our Memory Disorders Center for evaluation of her declining memory. Rosa Gonzalez had forgotten to turn off the stove on one occasion and had begun to forget the names of distant relatives. Otherwise, she was functioning quite well at home, managing her daily chores without any difficulties. The neurological, psychiatric, and brain imaging workup revealed no significant abnormalities, but her neuropsychological test results threw us into a quandary. She scored in the range that would merit a diagnosis of dementia. However, her subpar scores were most prominent in naming, language, and general knowledge. She couldn't name any of the past five American presidents. From a set of ten pictures of objects, she couldn't name five: a camel, dominoes, a pretzel, a tennis racquet, and an igloo. On the Selective Reminding Test, which requires repeated learning and recall of a list of common nouns (like apple, chair, sky), she scored slightly below normal for someone of her age.
Rosa was tested in Spanish by a native Spanish-speaker. We expected Rosa to have difficulties in general knowledge and naming, because the tests are culturally biased against someone who did not grow up in the United States. However, tests of memory are more immune from cultural effects, and her below normal performance on the test requiring recall of a list of common nouns suggested a real deficit. Rosa Gonzalez supposedly had eight years of education, but on further discussion with her daughter it became clear that she'd had only four years of formal schooling.
Education is well known to have a major impact on performance for most cognitive tests, though less so for memory. I thought that this was probably age-related memory loss and not early dementia but wasn't sure. During the next four years, Rosa Gonzalez did not worsen in her neuropsychological test performance, confirming that she indeed did have memory loss due to aging and not a dementing process like Alzheimer's disease.
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