Application of the modified qualitative scoring of MMSE pentagon test in the differential diagnosis of lewy body dementia and Alzheimer’s disease

Abstract

AbstractBackgroundTo explore the value of the modified qualitative scoring of MMSE pentagon test (mQSPT) in the differential diagnosis of Lewy body dementia (DLB) and Alzheimer’s disease (AD).MethodStudy the patients who met the inclusion criteria in the Department of Neurology, Xuanwu Hospital, Capital Medical University from January 2018 to August 2021. The baseline data of gender, age and education, Mini‐Mental State Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA) and Clinical Dementia Assessment Scale (CDR) scores of 61 DLB patients and 71 AD patients were analyzed retrospectively. At the same time, the scores of sub items in the scale that can reflect visualspatial impairment were recorded,: i.e. connection test, cube copy, clock drawing test in MoCA, and pentagon copy test in MMSE. The images in MMSE pentagon copy test of these patients were further scored according to QSPT and mQSPT, and compared between the two groups. Multivariate stepwise logistic regression was used to analyze the differential efficacy of QSPT, mQSPT combined with other clinical psychological evaluation between DLB and AD.ResultThere were significant differences between DLB and AD patients in connection test, cube copy, clock drawing test, pentagon copy test, QSPT, mQSPT and gender, but there were no significant differences in MMSE, MoCA, age and education. The sensitivity of QSPT in differentiating DLB and AD was 71.8%, the specificity was 67.2%, the area under ROC curve was 0.682 (95%CI: 0.584‐0.772), and the cut‐off value was 9.5. The sensitivity of mQSPT in differentiating DLB and AD was 68.9%, the specificity was 84.5%, the area under ROC curve was 0.78 (95%CI: 0.696‐0.862), and the cut‐off value was 8.5. Multivariate stepwise logistic regression showed that while QSPT failed to establish any suitable modeling, mQSPT and cube copy were related to the distinction between the two diseases. Moreover, the efficacy of these two indexes to distinguish AD and DLB: the sensitivity was 70.5%, and the specificity was 84.1% and the area under the ROC curve was 0.817(95%CI: 0.743‐0.891).ConclusionThe mQSPT can be used for the screening tool in differential diagnosis between AD and DLB patients.