5 - The Nature and Magnitude of Congitive Dysfunction in Preclinical Alzheimer's Disease: What The Disease Tells Us About Neuropsychology and What Neuropsychology Tells Us About The Disease

The development of biomarkers for Alzheimer’s disease (AD) allows the disease to be detected and followed up to 20 years before dementia diagnosis. This stage, called preclinical AD, provides neuropsychologists with an ideal opportunity to develop methods for the early characterization of AD- related cognitive dysfunction. Additionally, we can exploit the subtle and relatively specific AD-related biological changes to challenge brain-behavior models that guide our decision making. In this talk, I will discuss cognitive dysfunction in preclinical AD and highlight how our attempting to understand this disease stage with both conventional and computerized cognitive tests provide new challenges and lessons for the field of neuropsychology. These arise in decisions about (a) cognitive change and cognitive impairment, (b) normal cognitive aging vs. very early dementia, (c) differences in information obtained from clinical research and clinical practice, and (d) how remote or unsupervised assessment of cognition could aid neuropsychological decision-making. I will finish by discussing my thoughts on how neuropsychological decisions about very early AD might be influenced by the growing availability of AD disease biomarkers and what the term ‘clinically important’ means.