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Diagnostic performance of a combination of Mini-Mental State Examination and Clock Drawing Test in detecting Alzheimer’s disease

Authors Kato Y, Narumoto J, Matsuoka T, Okamura A, Koumi H, Kishikawa Y, Terashima S, Fukui K

Received 31 December 2012

Accepted for publication 4 March 2013

Published 30 April 2013 Volume 2013:9 Pages 581—586

DOI https://doi.org/10.2147/NDT.S42209

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4


Yuka Kato,1 Jin Narumoto,1 Teruyuki Matsuoka,1 Aiko Okamura,1 Hiroyuki Koumi,2 Yusuke Kishikawa,3 Shigenori Terashima,4 Kenji Fukui1

1Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; 2Department of Clinical Psychology, Faculty of Social Welfare, Hanazono University, Kyoto, Japan; 3Misatopia Ogura Hospital, Nagano, Japan; 4Graduate School of Psychology, Kansai University, Osaka, Japan

Objective: Because of the growing need for quick cognitive screening tests to distinguish Alzheimer’s disease (AD) from mild cognitive impairment (MCI), we compare the diagnostic performance of a combination of the Mini-Mental State Examination (MMSE) and a Clock Drawing Test (CDT) to the Japanese version of the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-J cog) in differentiating between patients with AD, patients with MCI, and healthy controls (HC).
Methods: Data from 146 subjects with AD and 60 subjects with MCI, as well as 49 HC, was retrospectively analyzed. We used logistic regression analysis with diagnosis as dependent variables and scores of the MMSE, the CDT-command, and the CDT-copy as independent variables, and receiver operating characteristic analysis to distinguish patients with AD from patients with MCI or HC.
Results: When patients with AD were compared to HC, the independent predictors of AD were scores on the MMSE and the CDT-command. This combination was more sensitive than the MMSE alone and has nearly the same sensitivity and specificity as the ADAS-J cog. When patients with AD were compared to patients with MCI, the independent predictors were the MMSE and the CDT-copy. This combination was more sensitive and specific than the MMSE alone and was almost as sensitive and specific as the ADAS-J cog.
Conclusion: The combination of the MMSE and the CDT could be a powerful screening tool for differentiating between patients with AD, patients with MCI, and HC. Its sensitivity and specificity are comparable to ADAS-J cog, which takes more time.

Keywords: diagnostic techniques, Alzheimer’s disease, mild cognitive impairment, Clock Drawing Test, Mini-Mental State Examination

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