Auditory Verbal Learning Test-huashan Version Is Superior To MMSE And MoCA For Early Diagnosis Of Amnesia Mild Cognitive Impairment

Objective:As the key to the early diagnosis and intervention of Alzheimer’ disease(AD),the recognition of mild cognitive impairment(MCI)is a hot topic in the domestic and overseas.In this study,we aimed to compare the early diagnostic value of auditory verb learn test-Huashan version(AVLT-H),the minimental state examination(MMSE)and Montreal cognitive assessment scale(MoCA)for amnestic MCI(aMCI),and explore an effective neuropsychological scale for aMCI.Methods:36 cases of aMCI patients and 27 cases of AD patients who were in line with relevant diagnostic criteria were recruited from the memory disorders clinic or the department of neurology of the First Affiliated Hospital of Soochow University during December 2015 and February 2017.Meanwhile,32 cases of normal cognitive elderly volunteers without objective cognitive impairment were recruited as control group(NC group).All the subjects being informed consent were performed neurophychological tests,which included the minimental state examination(MMSE),Montreal cognitive assessment scale(MoCA)and Auditory verb learn test-Huashan version(AVLT-H)as well as Clinical dementia rating scale(CDR),Activity of daily living scale(ADL),Hachinski Ischemic Score(HIS)ect.Using SPSS 22.0 statistical software to process the data,we analyzed the diagnostic features of AVLT-H memory scores for aMCI and compared the diagnostic value of AVLT-H,MMSE and Mo CA for aMCI.Results:1.The related factors(gender,age,educated level)analysis of the score of scalesMMSE and MoCA were significantly negative associated with age(P<0.05),and were significantly positive associated with educated level(P<0.05),but no significant correlation with sex were found(P>0.05).The immediate recall,short delayed recall and long delayed recall of AVLT-H were significantly associated with age(P<0.05),but no significantly association with sex and education were found(P>0.05)。2.Stratification according to age and education levelNC group,aMCI group and mild AD group were divided by three age level(55~64 year old,65~74 year old and 75 year old and above)and three education level(junior high school,high school and college),then we compared their distribution among three groups.The results showed that no significant difference was found among three groups(P>0.05).Educational level of every age level among the three group also found no significant difference(P>0.05).3.Comparison of each memory score of AVLT-H according age stratification of three groupsThe memory scores of AVLT-H of three groups were decreased with the elevation of age;every age level of three group were found mild AD group < aMCI group < NC group(P<0.05),and every two comparison has significant difference(P<0.05).4.Memory scores distribution characteristics among mild AD,aMCI and NC group and age layered of aMCIThe memory scores of three group were found mild AD group < aMCI group < NC group.The first three memory scores showed an eleveted trend,and delyed memory scores showed a decrease trend,scores were increased after clues remined.It is worth mentioning that the scores of NC group showed an obvious increasing trend after clues remined.The first three memory scores of different age level of aMCI group showed an increase trend,and achieve the same level at the third recall;with the interval extension,the delyed memory score showed a decrease trend,and the more older,the more quickly;scores were increased after clues remined.5.Comparison of diagnostic value for aMCI among MMSE,MoCA and AVLT-H delayed memoriesFor diagnisis of aMCI,MMSE,MoCA and the short delayed recall and long delayed recall of AVLT-H all have high area under the ROC curve(0.949,0.980,0.983 and 0.993).Take 27 as the critical value of MMSE,there was high sensitivity(91.6%),but the specificity was low(76.4%).Take 26 as the critical value of MoCA,the sensitivity was 100%,the specificity was 84.5%.Take 5 and 4 as the critical value for AVLT-H short delayed recall and long delayed recall respectively,there were highest sensitivity and specificity(93.3%,93.5% and 94.2%,100%).Conclusion:1.By comparing the diagnostic value of MMSE,MoCA and AVLT-H for aMCI,it was found that the short delayed memory and the long delayed memory of AVLT-H had the highest sensitivity and specificity,followed by MoCA.AVLT-H has higher diagnosis value as its more detailed and more accurate evaluation for memory function.MoCA,as a comprehensive cognitive function assessment acale,has good recognition effect for aMCI.MMSE is more suitable for patients with dementia,who has significant cognitive impairment,and are not recommended used for identification of aMCI or very mild dementia.2.The scores of NC group showed an obvious increasing trend after clues remined,this may be used as the basis for identify aMCI from normal aging.3.The short delayed recall of AVLT-H can better identify aMCI in a relatively short period of time,would have good prospect in clinical application.