Memory Alteration Test to Detect Amnestic Mild Cognitive Impairment and Early Alzheimer's Dementia in Population with Low Educational Level.

Nilton Custodio,Rosa Montesinos,Lucía Valeriano-Lorenzo,José Cuenca-Alfaro,Eder Herrera-Perez,Sheila Castro-Suarez,David Lira

doi:10.3389/fnagi.2017.00278

Nilton Custodio, Rosa Montesinos + Show 5 more

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https://doi.org/10.3389/fnagi.2017.00278

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Abstract

Background/Aims: Short tests to early detection of the cognitive impairment are necessary in primary care setting, particularly in populations with low educational level. The aim of this study was to assess the performance of Memory Alteration Test (M@T) to discriminate controls, patients with amnestic Mild Cognitive Impairment (aMCI) and patients with early Alzheimer’s Dementia (AD) in a sample of individuals with low level of education.Methods: Cross-sectional study to assess the performance of the M@T (study test), compared to the neuropsychological evaluation (gold standard test) scores in 247 elderly subjects with low education level from Lima-Peru. The cognitive evaluation included three sequential stages: (1) screening (to detect cases with cognitive impairment); (2) nosological diagnosis (to determinate specific disease); and (3) classification (to differentiate disease subtypes). The subjects with negative results for all stages were considered as cognitively normal (controls). The test performance was assessed by means of area under the receiver operating characteristic (ROC) curve. We calculated validity measures (sensitivity, specificity and correctly classified percentage), the internal consistency (Cronbach’s alpha coefficient), and concurrent validity (Pearson’s ratio coefficient between the M@T and Clinical Dementia Rating (CDR) scores).Results: The Cronbach’s alpha coefficient was 0.79 and Pearson’s ratio coefficient was 0.79 (p < 0.01). The AUC of M@T to discriminate between early AD and aMCI was 99.60% (sensitivity = 100.00%, specificity = 97.53% and correctly classified = 98.41%) and to discriminate between aMCI and controls was 99.56% (sensitivity = 99.17%, specificity = 91.11%, and correctly classified = 96.99%).Conclusions: The M@T is a short test with a good performance to discriminate controls, aMCI and early AD in individuals with low level of education from urban settings.

Highlights

MATERIALS AND METHODSMild cognitive impairment (MCI) is a well recognized risk factor for Alzheimer’s disease (AD), and for the predemential phase of this and other dementias (Albert et al, 2011; Li et al, 2011; Cooper et al, 2015)
There is a generalized low detection of dementia in the community. This is a real challenge in Latin America (LA; Lang et al, 2017), where previous studies showed that the majority of medical doctors perceive that their practices for diagnosis and treatment of dementia are inadequate, underscoring that this deficiency is higher in general practitioners than in specialists (Olavarria et al, 2015)
36 participants were not included in the present analysis because they were classified as non-amnesic METHODSMild cognitive impairment (MCI) (16), vascular dementia (6), Frontotemporal dementia (4), dementia associated with Parkinson’s disease (2) and other unspecified dementias (8)

Summary

Introduction

MATERIALS AND METHODSMild cognitive impairment (MCI) is a well recognized risk factor for Alzheimer’s disease (AD), and for the predemential phase of this and other dementias (Albert et al, 2011; Li et al, 2011; Cooper et al, 2015). The need for research aimed to AD early diagnosis have been highlighted in several studies directed towards the prevention and control of the worldwide progression of the disease (Richard et al, 2012; Barnett et al, 2013). There is a generalized low detection of dementia in the community. This is a real challenge in Latin America (LA; Lang et al, 2017), where previous studies showed that the majority of medical doctors perceive that their practices for diagnosis and treatment of dementia are inadequate, underscoring that this deficiency is higher in general practitioners than in specialists (Olavarria et al, 2015). Other challenge in LA countries is the lack of validated and standardized instruments to assess cognition and functionality in indigenous populations, in rural areas, with a language other than Spanish, or with low levels of education (Maestre, 2012; Parra, 2014)

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