Objective: Dementia screening in primary care (PC) settings is vital for the early detection and prolonged successful treatment of Alzheimer’s disease (AD). Time constraints limit the applications of possible screening tools in PC. Screening for memory impairment seems useful as it is the core feature of AD. The discriminative validity of the MIS and the conventional Three-Word-Memory-Test as well as the total score of the MMSE are compared.
Design: Cross-sectional study within a memory clinic using a Spanish adaptation of the MIS and the MMSE, containing the Three-Word-Memory Test, as part of a comprehensive neuropsychological and neurological evaluation.
Materials and Methods: A group of 145 subjects divided into 86 AD patients diagnosed according to DSM-IVR and NINCDS-ADRDA criteria and 59 controls, over 50 years, participated in the present study. Subjects received the MIS, a four word memory test using a specific encoding technique, as well as the Three-Word-Memory-Test and the MMSE as part of their neuropsychological workup. Subjects were divided into groups based on consensus diagnosis of two independent clinicians which did not include the MIS nor the MMSE.
Sensitivity, specificity and positive predictive value (PPV) were calculated for the MIS, the Three-Word-Memory-Test and the total MMSE as screening tests for AD. ROC curves for the discrimination between AD subjects and controls were plotted for the three tests.
Results: Control subjects were significantly younger and better educated than the demented samples (p<0.001). No sex differences could be established between samples. Age and education adjusted ROC curves demonstrated high discriminative validity for the MIS (0.995) which clearly outperformed the Three-Word-Memory-Test (0.793). The results for an age and education adjusted total score of the MMSE were similar though lower than those for the MIS (0.953). Sensitivity, specificity and PPV values strongly favoured the MIS over the Three-word-memory test. The MIS also seems to be more sensitive to AD memory impairment than the MMSEtot (0.99 vs. 0,80).
Conclusion: Given the discriminative validity of the Spanish version of the MIS, as well as its better normative data together with the advantage of its brevity, the MIS seems to be an important tool for AD screening in primary care as well as in non-specialized neurological unit settings.
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