Development of a screening algorithm for Alzheimer's disease using categorical verbal fluency

PLoS One. 2014 Jan 2;9(1):e84111. doi: 10.1371/journal.pone.0084111. eCollection 2014.

Abstract

We developed a weighted composite score of the categorical verbal fluency test (CVFT) that can more easily and widely screen Alzheimer's disease (AD) than the mini-mental status examination (MMSE). We administered the CVFT using animal category and MMSE to 423 community-dwelling mild probable AD patients and their age- and gender-matched cognitively normal controls. To enhance the diagnostic accuracy for AD of the CVFT, we obtained a weighted composite score from subindex scores of the CVFT using a logistic regression model: logit (case) = 1.160+0.474× gender +0.003× age +0.226× education level - 0.089× first-half score - 0.516× switching score -0.303× clustering score +0.534× perseveration score. The area under the receiver operating curve (AUC) for AD of this composite score AD was 0.903 (95% CI = 0.883 - 0.923), and was larger than that of the age-, gender- and education-adjusted total score of the CVFT (p<0.001). In 100 bootstrapped re-samples, the composite score consistently showed better diagnostic accuracy, sensitivity and specificity for AD than the total score. Although AUC for AD of the CVFT composite score was slightly smaller than that of the MMSE (0.930, p = 0.006), the CVFT composite score may be a good alternative to the MMSE for screening AD since it is much briefer, cheaper, and more easily applicable over phone or internet than the MMSE.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Algorithms*
  • Alzheimer Disease / diagnosis*
  • Area Under Curve
  • Case-Control Studies
  • Female
  • Humans
  • Male
  • Neuropsychological Tests
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • Speech Production Measurement / methods*

Grants and funding

This study was supported by the grant of the Korean Health Technology R&D Project, Ministry for Health, Welfare, & Family Affairs, Republic of Korea (Grant No. A092077), and by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MEST; Grant No. 2011-0018262). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.