Predictive value of selected neuropsihological tests in the diagnosis of mild cognitive impairment and dementia

U evaluaciji kognitivnih promena karakterističnih za Alzheimer-ovu bolest (AB) i blagi kognitivni poremećaj (BKP) u odnosu na normalno starenje, neuropsihološko ispitivanje danas ima primat u odnosu na sve ostale metode. Cilj rada bio je da se utvrdi dijagnostička vrednost odabranih neuropsiholoških testova u razlikovanju osoba sa demencijom u AB i BKP međusobno kao i u odnosu na normalno starenje, odrede granične vrednosti korisne u kliničkom radu i optimalna baterija testova koja će omogućiti najtačniju klasifikaciju. METOD: Istraživanje je sprovedeno u Centru za poremećaje pamćenja i demencije Klinike za neurologiju, Kliničkog Centra Srbije, u periodu od marta 2010. do septembra 2015. godine, gde je, iz primarne kohorte koju čini 2198 ispitanika koji se prate neurološki i neuropsihološki od septembra 2008. godine, regrutovano 444 ispitanika, starijih od 60 godina, koji su u razmaku od godinu dana u dva navrata neuropsihološki testirani (183 pacijenta sa dijagnozom AB, 132 sa dijagnozom BKP i 129 zdravih ispitanika koji su činili kontrolnu grupu). Baterija neuropsiholoških testova obuhvatila je sledeće testove: 1) testove globalnog kognitivnog funkcionisanja: Mini Mental State Examination (MMSE), Clock Drawing Test (CDT), Addenbrooke's Cognitivne examination – revised (ACE-R), Mattis-ovu skalu za procenu demencije, 2) testove verbalnog epizodičkog pamćenja: The Free and Cued Selective Reminding Test - Grober - Buschke (FCSRT-GB), Rey Auditory Verbal Learning Task (RAVLT), 3) testove verbalne fluentnosti – Fonemska i kategorijalna fluentnost (FF i KF), 4) test konfrontacionog imenovanja: Boston Naming Test (BNT). REZULTATI: Test sa najvećom dijagnostičkom preciznošću izdvaja se ACE - R, sa optimalnom cut off vrednošću za razlikovanje kognicije zdravih od osoba sa BKP 82,5 (Se 0.800, Sp 0.907) i u razlikovanju kognicije osoba sa BKP u odnosu na umerenu AB cut off vrednošću 70,5 (Se 0.852, Sp 0.856). Od domenski orijentisanih testova izdavaja se domen verbalnog epizodičkog pamćenja, ispitivan pomoću RAVLT i FCSRT - GB, gde je, u evaluaciji kognicije zdravih od osoba sa BKP najdistinktivniji domen...In the evaluation of cognitive changes characteristic of Alzheimer's disease (AD) and mild cognitive impairment (MCI) in relation to normal aging, neuropsychological testing has primacy today comparing to other methods. The aims of this study was to determine the diagnostic value of selected neuropsychological tests in distinguishing dementia in AD and MCI from each other as well as in relation to normal aging, determining the cut off values useful in clinical work and the optimal battery of tests that will enable the most accurate classification. METHOD: The research was conducted at the Center for memory disorders and dementia at Neurology Clinic of the Clinical Center of Serbia in the period from March 2010. to September 2015. From a primary cohort of the Center, comprised of 2198 subjects and monitored neurologically and neuropsychologically since September 2008., 444 subjects over 60 years of age were recruited. All subject were neuropsychologically tested and retested after one year (183 patients diagnosed with AD, 132 with MCI diagnosis and 129 healthy subjects who constituted a control group). The battery of neuropsychological tests included the following tests: 1) global cognitive function tests: Mini Mental State Examination (MMSE), Clock Drawing Test (CDT), Addenbrooke's Cognitive Examination - Revised (ACE-R), Mattis Scale for Dementia Assessment, 2) verbal episodic memory: The Free and Cued Selective Reminding Test - Grober - Buschke (FCSRT-GB), Rey Auditory Verbal Learning Task (RAVLT), 3) Verbal fluency: Phonemic and category fluency tests (FF and CF), 4) Confrontation naming: Boston Naming Test (BNT). RESULTS: A test with the highest diagnostic precision we obtained ACE - R, and determined optimal cut off value 82.5 (Se 0.800, Sp 0.907) to differentiate between healthy control and persons with MCI, and cut off value 70.5 (Se 0.852, Sp 0.856) to differentiate between individuals with MCI and patients with moderate AD. From domain-oriented tests, a domain of verbal episodic memory was obtained as a the most accurate, tested with RAVLT and FCSRTGB..