Santagata Francesca, Cappa Stefano F, Presta Roberto, Burgio Caterina, Luppi Chiara, Massaia Massimiliano, Calvi Elisa, D'Amelio Patrizia
Center for Cognitive Disorders and Dementia, Section of Geriatrics, City of Health and Science University Hospital, Turin, Italy.
University Institute for Advanced Studies IUSS, Pavia, Italy.
Aging Clin Exp Res. 2025 Apr 18;37(1):127. doi: 10.1007/s40520-025-03028-1.
The differential diagnosis between Alzheimer's disease (AD) and other causes of dementia is essential but challenging. Therefore, there is an increasing need for early, reliable, and non-invasive tests to distinguish between different forms of dementia.
To determine whether neuropsychological tests assessing visuospatial function can improve confidence in the clinical diagnosis of AD.
Retrospective observational single-center cohort study involving all patients consecutively referred to our outpatient clinic for cognitive disorders who underwent neuropsychological assessment between 2013 and 2018. In addition to demographic and functional variables, each patient underwent neuropsychological tests to assess cognitive performance, memory, and executive, language, and visuospatial ability, according to clinical protocols. The clinical diagnosis of cognitive disorders, based on standard diagnostic criteria, served as the gold standard. Accuracy measures of visuospatial tests to diagnose AD were calculated. Additionally, a new index derived from the sum of four items (Rey-Osterrieth figure copying, Copy of Drawings, Clock Drawing Test, and years of schooling) was tested (ReDCOOL).
Of the 342 patients analyzed, 308 were diagnosed with dementia or mild cognitive impairment, including 60 with AD. AD patients exhibited the worst performance in visuospatial tests, and the utilization of the ReDCOOL index proved to be more dependable in identifying AD compared to other tests (AUROC 0.729, 95%CI 0.659-0.799; p < 0.001).
The ReDCOOL index appears to increase confidence in the clinical diagnosis of AD compared to each of the visuospatial tests considered. Furthermore, this index is easily calculated and does not prolong the time needed for clinical evaluation, as it does not require a customized patient assessment.
阿尔茨海默病（AD）与其他痴呆病因的鉴别诊断至关重要但具有挑战性。因此，越来越需要早期、可靠且非侵入性的检测方法来区分不同形式的痴呆。
确定评估视觉空间功能的神经心理学测试是否能提高对AD临床诊断的信心。
回顾性观察单中心队列研究，纳入2013年至2018年间连续转诊至我们门诊进行认知障碍评估的所有患者。除人口统计学和功能变量外，根据临床方案，每位患者均接受神经心理学测试以评估认知表现、记忆、执行、语言和视觉空间能力。基于标准诊断标准的认知障碍临床诊断作为金标准。计算视觉空间测试诊断AD的准确性指标。此外，还测试了一个由四个项目（雷-奥斯特里赫图形临摹、绘图临摹、画钟测试和受教育年限）之和得出的新指标（ReDCOOL）。
在分析的342例患者中，308例被诊断为痴呆或轻度认知障碍，其中60例为AD。AD患者在视觉空间测试中表现最差，与其他测试相比，ReDCOOL指标在识别AD方面被证明更可靠（曲线下面积0.729，95%置信区间0.659 - 0.799；p < 0.001）。
与所考虑的各项视觉空间测试相比，ReDCOOL指标似乎能提高对AD临床诊断的信心。此外，该指标计算简便，且不会延长临床评估所需时间，因为它不需要对患者进行定制评估。
