Abstract
We developed a weighted composite score of the categorical verbal fluency test (CVFT) that can more easily and widely screen Alzheimer's disease (AD) than the mini-mental status examination (MMSE). We administered the CVFT using animal category and MMSE to 423 community-dwelling mild probable AD patients and their age- and gender-matched cognitively normal controls. To enhance the diagnostic accuracy for AD of the CVFT, we obtained a weighted composite score from subindex scores of the CVFT using a logistic regression model: logit (case) = 1.160+0.474× gender +0.003× age +0.226× education level – 0.089× first-half score – 0.516× switching score -0.303× clustering score +0.534× perseveration score. The area under the receiver operating curve (AUC) for AD of this composite score AD was 0.903 (95% CI = 0.883 – 0.923), and was larger than that of the age-, gender- and education-adjusted total score of the CVFT (p<0.001). In 100 bootstrapped re-samples, the composite score consistently showed better diagnostic accuracy, sensitivity and specificity for AD than the total score. Although AUC for AD of the CVFT composite score was slightly smaller than that of the MMSE (0.930, p = 0.006), the CVFT composite score may be a good alternative to the MMSE for screening AD since it is much briefer, cheaper, and more easily applicable over phone or internet than the MMSE.
Highlights
With the world population aging, the number of dementia patients worldwide will be increasing rapidly
Among the 6 index scores of the categorical verbal fluency test (CVFT), the first-half, second-half and switching scores were lower in the Alzheimer’s disease (AD) group than in the control group (p,.001)
We developed a weighted composite score of the CVFT that was considerably more accurate in diagnosing AD than the conventional CVFT total score using quantitative and qualitative differences in performance on CVFT in AD patients and normal controls
Summary
With the world population aging, the number of dementia patients worldwide will be increasing rapidly. The number of dementia patients is projected to double every 20 years to 2.1 million and the national cost of dementia every 10 years to 73.8 billion USD by 2050 in South Korea [1,2]. As more interventions for AD become available, there is an increasing need for screening tests that can accurately detect early-stage AD. A range of health care personnel should be able to quickly and administer it. It would be so much the better the test can be self-administered without assistance from health care personnel
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