PRESERVED COGNITIVE SKILLS IN DEMENTIA OF THE ALZHEIMER-TYPE

Objective: To describe preserved cognitive skills in patients with dem entia. Design: Case series. Setting: Community clinic. Patients: Five patients who met National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Associa tion criteria for probable Alzheimer's disease and were claimed to ret ain a cognitive skill. Interventions: None. Main Outcome Measures: Sta ndard neuropsychological tests and individualized measures of patients ' skilled behaviors. For patients who remained skilled at games, perfo rmance was compared with that of normal controls in direct competition . For the patient-trombonist, raters compared premorbid and postmorbid recordings of his play. Results: One patient continued to play the tr ombone in a Dixieland band, although he could not name wellknown numbe rs that he played. Another continued to solve adult jigsaw puzzles. A third patient retained skill at canasta, the fourth at dominoes. The f ifth patient remained a skillful contract bridge player, although he c ould not name the suits or articulate simple bidding rules. Four patie nts had impaired performance on standard anterograde and remote memory and naming tests but performed normally on pursuit rotor and letter f luency tests. Mini-Mental State Examination scores for these patients ranged from 10 to 22. One patient refused neuropsychological testing b ut displayed his skill. Conclusions: Together with previous studies of preserved piano playing or painting skills, our findings indicate tha t a broad range of complex cognitive abilities may be preserved in pat ients with dementia of the Alzheimer type who cannot perform simpler a ctions.