Serna Adriana, Contador Israel, Bermejo-Pareja Félix, Mitchell Alex J, Fernández-Calvo Bernardino, Ramos Francisco, Villarejo Alberto, Benito-León Julián
Department of Personality, Evaluation and Psychological Treatment, University of Salamanca, Salamanca, Spain.
Department of Basic Psychology, Psychobiology and Methodology of Behavioral Science, University of Salamanca, Salamanca, Spain.
J Alzheimers Dis. 2015;48(1):163-73. doi: 10.3233/JAD-150086.
Early separation of mild cognitive impairment (MCI) from normal aging and mild cases of dementia remains a challenge, especially in the general population. We aimed to analyze the diagnostic accuracy of a brief neuropsychological battery (BNB) in dementia and MCI cases from the Neurological Disorders in Central Spain (NEDICES) population-based cohort study. We screened 3,891 participants into dementia and non-dementia groups using a two-phase procedure: screening (MMSE-37 and Pfeffer-11) and clinical diagnosis by specialists (DSM-IV criteria). We selected subsequently a subsample of dementia (n = 98), MCI (n = 71), and cognitively healthy (n = 123) participants matched in socio-demographic characteristics. The clinical validity of each test of the BNB was determined by the area under the ROC curve. We determined the best combination of tests to classify individuals into the diagnostic groups by logistic regression analyses. The results indicated that dementia and MCI groups could be best discriminated from the healthy control group on the basis of their scores on the semantic verbal fluency and delayed recall subtests of the BNB. As for discriminating the MCI group from the dementia group, immediate recall tasks (stories and pictures) yielded the highest level of accuracy. Probably the most interesting finding is that the verbal fluency task consistently allowed discrimination among the diagnostic groups. Overall, subtests of the BNB are more accurate in differentiating dementia patients than MCI patients from healthy controls. In this population-based sample, a more fine-grained discrimination that includes MCI patients should follow a systematic subtest-wise analysis and decision.
早期区分轻度认知障碍（MCI）与正常衰老及轻度痴呆病例仍然是一项挑战，尤其是在普通人群中。我们旨在分析基于西班牙中部神经系统疾病（NEDICES）人群队列研究中，简易神经心理成套测验（BNB）在痴呆和MCI病例中的诊断准确性。我们采用两阶段程序将3891名参与者分为痴呆组和非痴呆组：筛查（MMSE - 37和Pfeffer - 11）以及由专家进行临床诊断（DSM - IV标准）。随后，我们选取了痴呆（n = 98）、MCI（n = 71）和认知健康（n = 123）参与者的一个子样本，这些参与者在社会人口学特征上相匹配。BNB每项测试的临床有效性通过ROC曲线下面积来确定。我们通过逻辑回归分析确定将个体分类到诊断组的最佳测试组合。结果表明，根据BNB的语义言语流畅性和延迟回忆子测试得分，痴呆组和MCI组与健康对照组能得到最佳区分。至于区分MCI组和痴呆组，即时回忆任务（故事和图片）的准确性最高。可能最有趣的发现是言语流畅性任务始终能够区分不同诊断组。总体而言，但在区分痴呆患者与健康对照组时，BNB的子测试对痴呆患者比MCI患者更准确。在这个基于人群的样本中，要对包括MCI患者在内进行更精细的区分，应遵循系统的逐个子测试分析和决策。
