To the Editor The report by Mak et al1 indicated that their patient demonstrated intact cognitive functioning as determined by the Mini-Mental State Examination (MMSE) score and detailed neurocognitive evaluation. Whereas this is an interesting case of a rare absence of apolipoprotein E (ApoE), analysis of the patient’s neuropsychological results reveals findings that call to question the authors’ contention that “detailed neurocognitive and retinal studies failed to demonstrate any defects.” Specifically, the neurocognitive examination included the MMSE score, which was within normal limits (28 of 30). However, examination of the details of the neuropsychological findings reported in the accompanying tables to the article yields a different picture. Specifically, it was noted that his memory was below expectation, demonstrating only 3, 6, 7, and 6 words learned on the short form of the California Verbal Learning Test. He also demonstrated impaired visual memory on the Benson Figure Memory test and impaired performance on the Boston naming test (10 of 15). In terms of visuospatial skills, it was noted that he was unable to accurately copy intersecting pentagons from the MMSE. As the patient reportedly completed the 11th grade with a C+/B− average, these scores are below expectation and, in fact, suggestive of significant cognitive impairment. We should also note that the statements regarding the inclusion of a “full series of neuropsychological testing” or “detailed neurocognitive and retinal studies” are somewhat of an overstatement because, generally, abbreviated forms of standard neuropsychological tests were used, and no detailed measures of executive function were included. As such, the neuropsychological evaluation was reduced from what would be considered a typical detailed neuropsychological evaluation.
Cullum CM, Weiner MF. Apolipoprotein E and Neurocognitive Function. JAMA Neurol. 2015;72(4):478. doi:10.1001/jamaneurol.2014.4702