Verbal fluency tests together with mini mental state examination may be useful in differentiating between dementia and mild cognitive impairment stages according to Alzheimer's disease clinical criteria

Year 2022, Volume: 47 Issue: 4, 1403 - 1411, 28.12.2022

Didem Öz , Yağmur Özbek İşbitiren , İlayda Kıyı , Görsev Yener

https://doi.org/10.17826/cumj.1179620

Cited By: 2

Abstract

Purpose: Short screening tests are frequently used in clinical practice for dementia screening and diagnosis. The Mini Mental State Examination (MMSE) is one of the most frequently used. MMSE is known to have high sensitivity for dementia. However, MMSE is often not sufficient in the differentiation of Mild Cognitive Impairment (MCI), which is considered a transitional stage between healthy aging and dementia, and in the differential diagnosis of dementia of Alzheimer's Disease type (ADD) and MCI. Verbal fluency tests (semantic and phonemic), which can be applied in a time-limited medical settings, can be used as an alternative to MMSE or when used with MMSE higher diagnostic accuracy can be obtained for the early stages of AD and MCI. The aim of this study is to present the sensitivity, specificity and cut-off points of MMSE, semantic and phonemic fluency tests determined by ROC curve analysis.
Materials and Methods: Age-education-sex matched 72 healthy individuals, 72 MCI and 72 AD dementia individuals were included in the study. MMSE, semantic and phonemic fluency tests were applied to all participants. Sensitivity and specificity values and cut-off scores of MMSE, semantic and phonemic fluency tests in distinguishing healthy, MCI and ADD individuals were obtained by ROC curve analysis.
Results: ROC analyses show that all three tests can significantly discriminate between healthy, ADD and MCI individuals. It was seen that the discrimination power of the MMSE was higher than the verbal fluency tests when the areas under the ROC curve were compared. The specificity of semantic fluency was found to be higher than MMSE and phonemic fluency in distinguishing individuals with ADD and MCI.
Conclusion: The findings of the study show that MMSE is stronger than semantic and phonemic fluency in distinguishing healthy individuals, but its specificity is lower than semantic fluency in distinguishing MCI and AD dementia. In order to increase the diagnostic accuracy, it may be effective to add verbal fluency tests, especially semantic fluency test, which can be applied in a short time, to clinical practice.

Keywords

Mini Mental, verbal fluency, dementia, diagnostic accuracy, MCI, Alzheimer’s disease

Alzheimer hastalığı klinik ölçütlerine göre demans ve hafif kognitif bozukluk ayrımında sözel akıcılık testlerinin mini mental durum testi ile birlikte kullanılması yararlı olabilir

Abstract

Amaç: Demans tarama ve tanısı için klinik pratikte sıklıkla kısa tarama testleri kullanılmaktadır. Mini Mental Durum Testi (MMDT) en sık kullanılan testlerin başında gelmektedir. MMDT’nin demans için duyarlı olduğu bilinmektedir. Ancak, sağlıklı yaşlanma ile demans arasında bir geçiş evresi olarak kabul edilen Hafif Kognitif Bozukluk (HKB)’un ayırt edilmesinde ve Alzheimer Hastalığı tipi demans (AHD) ile HKB’nin ayırıcı tanısında MMDT çoğu zaman yeterli olmamaktadır. Kısa sürede uygulanabilen sözel akıcılık testleri (semantik ve fonemik) MMDT’ye alternatif ya da MMDT ile kullanıldığında HKB ve AH’nin erken evreleri için tanısal doğruluğu daha yüksek bir tarama testi elde edilebilir. Bu çalışmanın amacı MMDT, semantik ve fonemik akıcılık testlerinin ROC eğrisi analizleri ile belirlenen duyarlılık, özgüllük ve kesme puanı değerlerinin sunulmasıdır.
Gereç ve Yöntem: Çalışmaya yaş-eğitim-cinsiyet açısından uyumlu 72 sağlıklı birey, 72 HKB ve 72 AHD’li birey dahil edilmiştir. Tüm katılımcılara MMDT, semantik ve fonemik akıcılık testleri uygulanmıştır. ROC eğrisi analizleri ile MMDT, semantik ve fonemik akıcılık testlerinin sağlıklı, HKB ve AHD’li bireyleri ayırt etmedeki duyarlılık ve özgüllük değerleri ile kesme puanları elde edilmiştir.
Bulgular: ROC analizleri her üç testin de sağlıklı, AHD ve HKB’li bireyleri istatistiksel olarak anlamlı şekilde ayırt edebildiğini göstermektedir. ROC eğrisi altında kalan alanlar karşılaştırıldığında MMDT’nin ayırt etme gücünün sözel akıcılık testlerinden yüksek olduğu görülmüştür. AHD ve HKB’li bireylerin ayrımında semantik akıcılığın özgüllüğü MMDT ve fonemik akıcılıktan yüksek bulunmuştur.
Sonuç: Çalışmanın bulguları MMDT’nin sağlıklı bireyleri ayırt etmede semantik ve fonemik akıcılıktan daha güçlü olduğunu, ancak HKB ve AH ayrımında özgüllüğünün semantik akıcılıktan düşük olduğunu göstermektedir. Tanı doğruluğunun artırılması için kısa zamanda uygulanabilen sözel akıcılık testlerinin, özellikle semantik akıcılık testinin klinik pratiğe eklenmesi yararlı olabilir.

Keywords

Mini-Mental, sözel akıcılık, demans, tanı doğruluğu, HKB, Alzheimer hastalığı

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