Department of Neurology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain.
Department of Psychiatry, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain.
J Alzheimers Dis. 2019;67(1):265-277. doi: 10.3233/JAD-171007.
Assessment of hippocampal amnesia is helpful to distinguish between normal cognition and mild cognitive impairment (MCI), but not for identifying converters to dementia. Here biomarkers are useful but novel neuropsychological approaches are needed in their absence. The In-out-test assesses episodic memory using a new paradigm hypothesized to avoid reliance on executive function, which may compensate for damaged memory networks.
To assess the validity of the In-out-test in identifying prodromal Alzheimer's disease (PAD) in a clinical setting, by comparing this to the Free and Cued Selective Reminding Test (FCSRT) and cerebrospinal fluid biomarkers.
A cross-sectional study of 32 cognitively healthy, 32 MCI, and 30 progressive dementia subjects. All participants were given both the In-out-test and the FCSRT; 40 of them also received a lumbar puncture.
Internal consistency was demonstrated using Cronbach Alpha (r = 0.81) and Inter-rater reliability with Kappa (k = 0.94). Intraclass correlation (ICC) for test-retest reliability: r = 0.57 (p = 0.57). ICC between the In-out-test and FCSRT r = 0.87 (p = 0.001). ICC between the In-out-test and Aβ42 and P-tau/Aβ42 for controls: 0.73 and 0.75, respectively; P-tau for MCI: 0.77 and total sample: 0.70; Aβ42 for dementia: 0.71. All ICC measures between FCSRT and biomarkers were ≤0.264. AD diagnosis: In-out-test k = 0.71; FCSRT k = 0.49. PAD diagnosis (N = 35): In-out-test k = 0.69; FCSRT k = 0.44.
The In-out-test detected prodromal AD with a higher degree of accuracy than a conventional hippocampal-based memory test. These results suggest that this new paradigm could be of value in clinical settings, predicting which patients with MCI will go on to develop AD.
评估海马体遗忘有助于区分正常认知和轻度认知障碍（MCI），但无法识别向痴呆症转化的患者。目前生物标志物具有一定的辅助作用，但在缺乏生物标志物的情况下，还需要新的神经心理学方法。内出测试采用新的范式评估情景记忆，假设该范式可以避免对执行功能的依赖，而执行功能可能会补偿受损的记忆网络。
通过与自由和线索选择性提醒测试（FCSRT）和脑脊液生物标志物进行比较，在临床环境中评估内出测试识别前驱期阿尔茨海默病（PAD）的有效性。
对 32 名认知健康者、32 名 MCI 患者和 30 名进行性痴呆患者进行横断面研究。所有参与者均接受内出测试和 FCSRT 测试；其中 40 人还接受了腰椎穿刺。
使用 Cronbach Alpha（r=0.81）和 Kappa（k=0.94）进行内部一致性测试，用内出测试和 FCSRT 之间的 ICC 测试可靠性，r=0.57（p=0.57）。测试重测信度的 ICC：r=0.57（p=0.57）。内出测试和 FCSRT 之间的 ICC：r=0.87（p=0.001）。内出测试与 Aβ42 和 P-tau/Aβ42 之间的 ICC 对对照组分别为 0.73 和 0.75，MCI 患者为 0.77，总样本为 0.70；Aβ42 对痴呆症为 0.71。FCSRT 与生物标志物之间的所有 ICC 测量值均≤0.264。AD 诊断：内出测试 k=0.71；FCSRT k=0.49。前驱期 AD 诊断（N=35）：内出测试 k=0.69；FCSRT k=0.44。
与传统基于海马体的记忆测试相比，内出测试更准确地检测到前驱期 AD。这些结果表明，这种新范式可能具有临床价值，可预测哪些 MCI 患者将发展为 AD。
