BACKGROUND: Identification of famous landmarks (FLI), famous faces (FFI) and recognition of facial emotions (FER) is affected early in the course of Alzheimer's disease (AD). FFI, FER and FLI may represent domain specific tasks relying on activation of distinct regions of the medial temporal lobe, which are affected successively during the course of AD. However, the data on FFI and FER in MCI are controversial and FLI domain remains almost unexplored. OBJECTIVES: To determine whether and how are these three specific domains impaired in head to head comparison of patients with amnestic MCI (aMCI) single domain (SD-aMCI) and multiple domain (MD-aMCI). We propose that FLI might be most reliable in differentiating SD-aMCI, which is considered to be an earlier stage of AD pathology spread out, from the controls. PATIENTS AND METHODS: A total of 114 patients, 13 with single domain (SD-aMCI) and 30 with multiple domains (MD-aMCI), 29 with mild AD and 42 controls underwent standard neurological and neuropsychological evaluations as well as tests of FLI, FER and FFI. RESULTS: Compared to the control group, AD subjects performed worse on FFI (p = 0.020), FER (p<0.001) and FLI (p<0.001), MD-aMCI group had significantly worse scores only on FLI (p = 0.002) and approached statistical significance on FER (0.053). SD-aMCI group performed significantly worse only on FLI (p = 0.028) compared to controls. CONCLUSIONS: Patients with SD-aMCI had an isolated impairment restricted to FLI, while patients with MD-aMCI showed impairment in FLI as well as in FER. Patients with mild dementia due to AD have more extensive impairment of higher visual perception. The results suggest that FLI testing may contribute to identification of patients at risk of AD. We hypothesize that clinical examination of all three domains might reflect the spread of the disease from transentorhinal cortex, over amygdala to fusiform gyrus.

Department of Neurophysiology of Memory Institute of Physiology Academy of Sciences of the Czech Republic Prague Czech Republic; Memory Clinic Department of Neurology Charles University Prague 2nd Faculty of Medicine and University Hospital Motol Prague Czech Republic

International Clinical Research Center St Anne's University Hospital Brno Brno Czech Republic

International Clinical Research Center St Anne's University Hospital Brno Brno Czech Republic; Memory Clinic Department of Neurology Charles University Prague 2nd Faculty of Medicine and University Hospital Motol Prague Czech Republic

International Clinical Research Center St Anne's University Hospital Brno Brno Czech Republic; School of Aging Studies University of South Florida Tampa Florida United States of America

Memory Clinic Department of Neurology Charles University Prague 2nd Faculty of Medicine and University Hospital Motol Prague Czech Republic

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Czech Brain Aging Study (CBAS): prospective multicentre cohort study on risk and protective factors for dementia in the Czech Republic