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European Journal of Medical Research

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Open Access 01-12-2023 | Mild Neurocognitive Disorder | Research

Bayesian estimation for the accuracy of three neuropsychological tests in detecting Alzheimer's disease and mild cognitive impairment: a retrospective analysis of the ADNI database

Authors: Xiaonan Wang, Fengjie Li, Jiang Tian, Qi Gao, Huiping Zhu

Published in: European Journal of Medical Research | Issue 1/2023

Abstract

Background

The neuropathological confirmation serves as the gold standard for diagnosing Alzheimer's disease (AD), but it is usually not available to the living individuals. In addition, the gold standard for diagnosing Mild Cognitive Impairment (MCI) remains unclear yet. Neuropsychological testing, such as the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), is commonly used tests in identifying AD and MCI, offering convenience, affordability, non-invasiveness, and accessibility in clinical settings. We aimed to accurately evaluate the discriminative ability of the three tests administrated at the same visit simultaneously in detecting AD and MCI due to AD in the absence of a gold standard.

Methods

A total of 1289 participants aged over 65 were included from the baseline visits of Alzheimer’s disease Neuroimaging Initiative. Bayesian latent class models, accounting for conditional dependence between MoCA and MMSE, were conducted to assess the diagnostic accuracy of the three tests for detecting AD and MCI.

Results

In detecting AD, the ADAS-cog had the highest Youden's Index (0.829), followed by the MoCA(0.813) and MMSE(0.796). The ADAS-cog and MoCA showed similar sensitivity (0.922 vs 0.912) and specificity (0.907 vs 0.901), while the MMSE had lower sensitivity (0.874) and higher specificity (0.922). For MCI detection, the ADAS-cog had the highest Youden's Index (0.704) compared to the MoCA (0.614) and MMSE (0.478). The ADAS-cog exhibited the highest sensitivity, closely followed by the MoCA and MMSE (0.869 vs 0.845 vs 0.757), and the ADAS-cog also had good specificity (0.835 vs 0.769 vs 0.721). The estimated true prevalence of AD among individuals aged over 65 was 20.0%, and the estimated true prevalence of MCI due to AD was 24.8%.

Conclusions

The findings suggest that the ADAS-cog and MoCA are reliable tools for detecting AD and MCI, while the MMSE may be less sensitive in detecting these conditions. A large underdiagnosis of the MCI and Alzheimer’s population still remains in clinical screening.

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Title: Bayesian estimation for the accuracy of three neuropsychological tests in detecting Alzheimer's disease and mild cognitive impairment: a retrospective analysis of the ADNI database
Authors: Xiaonan Wang
Fengjie Li
Jiang Tian
Qi Gao
Huiping Zhu
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Mild Neurocognitive Disorder
Alzheimer's Disease
Alzheimer's Disease
Published in: European Journal of Medical Research / Issue 1/2023
Electronic ISSN: 2047-783X
DOI: https://doi.org/10.1186/s40001-023-01265-6

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Bayesian estimation for the accuracy of three neuropsychological tests in detecting Alzheimer's disease and mild cognitive impairment: a retrospective analysis of the ADNI database

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

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Abstract

Background

Methods

Results

Conclusions

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