Comparison of four verbal memory tests for the diagnosis and predictive value of mild cognitive impairment (original) (raw)
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Verbal cued recall as a predictor of conversion to Alzheimer's disease in Mild Cognitive Impairment
International Journal of Geriatric Psychiatry, 2009
Objective This study was set up to investigate whether neuropsychological tests are able to predict conversion to AD among Mild Cognitive Impairment (MCI) patients. Methods At baseline the cognitive part of the Cambridge Examination for Mental Disorders of the Elderly (CAMCOG), the Mini Mental Status Examination (MMSE), the Geriatric Depression Scale (GDS), a Dutch variation of Rey's Auditory Verbal Learning Test, the Memory Impairment Screen plus (MISplus) and the Visual Association Test (VAT) were administered to 40 patients diagnosed with MCI. After 18 months, MCI-patients were reassessed and a follow-up diagnosis was established. Of those who were seen for follow-up (n ¼ 31), seven fulfilled (NINCDS-ADRDA) criteria of probable AD, while 24 did not convert. Results A binary logistic regression analysis showed that the MISplus contributed most to the prediction of conversion (OR ¼ 0.28, 95% CI 0.099-0.790). With a cut-off of 2 out of 6, a positive predictive value of 71.5%, a negative predictive value of 91.5% and an overall diagnostic accuracy of 87.0% were achieved. Conclusions This prospective, longitudinal study shows that a score of 0 or 1 out of 6 on the MISplus may be a good indicator of future (within 18 months) progression to AD among MCI-patients.
International Journal of Geriatric Psychiatry, 2008
Objectives The proposals for classifying the transitional range between normal, ageing-associated cognitive dysfunctions and those suggestive of evolution towards dementia do not clarify whether the profiles are risk indicators of later cognitive impairment or represent preclinical phases of dementia. Methods Retrospective study of the baseline neuropsychological performance of ten subjects with subjective complaints of memory loss which evolved to dementia within 2 years and who meet clinical and neurological diagnosis for Probable Alzheimer's Disease (Progression group). They were compared with 34 normal subjects (Normative group), 33 patients with subjective complaints of memory who in 2 year did not evolve towards dementia and presented a stable profile (Stable group), and 47 Alzheimer's patients (Alzheimer group). A broad neuropsychological battery was administered to assess a range of cognitive functions. Results The Progression group presented a globally poor baseline neuropsychological performance, except in Working Memory, with clear deficits in Episodic Memory and Visual Memory. In the logistic regression analysis, Delayed Verbal Memory was significant as prognostic value for 80 Á 5% of cases. Conclusion Deficit on Episodic and Visual Memory at least 1.5 SD below T ¼ 50 are preclinical manifestations of dementia in subjects with complain of memory loss. The use of broad neuropsychological batteries and the quantitative assessment of deficits is essential to identify and predict the risk of dementia.
Archives of General Psychiatry, 2006
Background: Verbal memory impairment, one of the earliest signs of Alzheimer's disease (AD), may help identify people with cognitive impairment, insufficient for a diagnosis of dementia (questionable dementia: QD), at risk of developing AD. Other cognitive parameters have been found that may indicate which people with QD will go on to develop dementia. Nevertheless, some researchers have reported only partial success in differentiating between mild AD and age related cognitive impairment. Objectives: To discover if there are early, pre-clinical cognitive markers that could help identify patients attending our memory clinic who were at risk of developing dementia. Methods: Multidisciplinary assessment of a consecutive sample of 195 patients with QD seen in a National Health Service hospital outpatient clinic; 135 seen for a mean follow up of 24.5 months. Results: Conversion rate to dementia was 27.4% (37 of 135). A diagnosis of probable or possible AD was made in 15.6% (21 of 135) of cases. Despite statistically significant differences in some cognitive tasks between those who did and those who did not go on to dement, Cox regression analyses failed to improve prediction rates markedly above base rates and were unstable. Conclusion: A large number of studies claim good prediction of conversion to dementia using cognitive test scores. Although this study produced similarly good sensitivity and specificity values, proper consideration of the statistical analyses and their clinical significance suggested that these prediction methods are currently too imprecise for clinical use. Use of cognitive indicators combined with neuroradiological, neuropathological, and genetic factors for predicting conversion to dementia might prove more reliable but may be beyond the scope of many geriatric services.
Journal of Alzheimer's disease : JAD, 2013
The most recent studies about mild cognitive impairment (MCI) are focused on the search for factors that make patients more vulnerable to conversion to dementia, mainly Alzheimer's disease (AD). The aim of this study was to determine which neuropsychological test performances, including episodic memory profiles, and genetic risk factors (APOE ε4) better predict early conversion to dementia among the four MCI subtypes. Data from 550 MCI patients were analyzed for the purpose of this study and were classified according to Petersen's criteria (2004), and also taking into account the absence (probable MCI) or presence (possible MCI) of comorbidities…
Cognitive and Behavioral Neurology, 2006
Objective: Individuals with mild cognitive impairment (MCI) typically demonstrate memory loss that falls between normal aging (NA) and Alzheimer disease (AD), but little is known about the pattern of memory dysfunction in MCI. Method: To explore this issue, California Verbal Learning Test (CVLT) performance was examined across groups of MCI, AD, and NA. Results: MCI subjects displayed a pattern of deficits closely resembling that of AD, characterized by reduced learning, rapid forgetting, increased recency recall, elevated intrusion errors, and poor recognition discriminability with increased falsepositives. MCI performance was significantly worse than that of controls and better than that of AD patients across memory indices. Although qualitative analysis of CVLT profiles may be useful in individual cases, discriminant function analysis revealed that delayed recall and total learning were the best aspects of learning/memory on the CVLT in differentiating MCI, AD, and NA. Conclusions: These findings support the position that amnestic MCI represents an early point of decline on the continuum of AD that is different from normal aging.
The Hopkins Verbal Learning Test and Detection of MCI and Mild Dementia: A Literature Review
Journal of Alzheimer's Disease & Parkinsonism, 2014
A decline in verbal memory is one of the primary symptoms found in amnestic Mild Cognitive Impairment (aMCI) and most types of dementia. To detect verbal memory impairment in clinical and research settings, the Hopkins Verbal Learning Test (HVLT) has been recommended. In the current paper, the utility of the HVLT for aMCI/mild dementia diagnostics, as well as its use in treatment studies is reviewed. The HVLT was considered to have good diagnostic accuracy, be well tolerated and applicable across cultures. Optimal cutoffs for MCI and mild dementia are discussed and their possible relation to demographic factors such as age, gender, ethnicity and education.
Aging, …, 2009
Episodic memory is the first and most severely affected cognitive domain in Alzheimer's disease (AD), and it is also the key early marker in prodromal stages including amnestic mild cognitive impairment (MCI). The relative ability of memory tests to discriminate between MCI and normal aging has not been well characterized. We compared the classification value of widely used verbal memory tests in distinguishing healthy older adults (n = 51) from those with MCI (n = 38). Univariate logistic regression indicated that the total learning score from the California Verbal Learning Test-II (CVLT-II) ranked highest in terms of distinguishing MCI from normal aging (sensitivity = 90.2; specificity = 84.2). Inclusion of the delayed recall condition of a story memory task (i.e., WMS-III Logical Memory, Story A) enhanced the overall accuracy of classification (sensitivity = 92.2; specificity = 94.7). Combining Logical Memory recognition and CVLT-II long delay best predicted progression from MCI to AD over a 4-year period (accurate classification = 87.5%). Learning across multiple trials may provide the most sensitive index for initial diagnosis of MCI, but inclusion of additional variables may enhance overall accuracy and may represent the optimal strategy for identifying individuals most likely to progress to dementia.
Journal of Neuropsychology, 2015
In the field of neuropsychology, it is essential to determine which neuropsychological tests predict Alzheimer's disease (AD) in people with mild cognitive impairment (MCI) and which cut-off points should be used to identify people at greater risk for converting to dementia. The aim of the present study was to analyse the predictive value of the cognitive tests included in a neuropsychological battery for conversion to AD among MCI participants and to analyse the influence of some sociodemographic variables - sex, age, schooling - and others, such as follow-up time and emotional state. A total of 105 participants were assessed with a neuropsychological battery at baseline and during a 3-year follow-up period. For the present study, the data were analysed at baseline. During the follow-up period, 24 participants (22.85%) converted to dementia (2.79 ± 1.14 years) and 81 (77.14%) remained as MCI. The logistic regression analysis determined that the long delay cued recall and the performance time of the Rey figure test were the best predictive tests of conversion to dementia after an MCI diagnosis. Concerning the sociodemographic factors, sex had the highest predictive power. The results reveal the relevance of the neuropsychological data obtained in the first assessment. Specifically, the data obtained in the episodic verbal memory tests and tests that assess visuospatial and executive components may help to identify people with MCI who may develop AD in an interval not longer than 4 years, with the masculine gender being an added risk factor.