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Meta-Analysis
. 2017 Dec;27(4):354-388.
doi: 10.1007/s11065-017-9360-6. Epub 2017 Sep 22.

Diagnostic Accuracy of Memory Measures in Alzheimer's Dementia and Mild Cognitive Impairment: a Systematic Review and Meta-Analysis

Gali H Weissberger  1   2 , Jessica V Strong  2   3 , Kayla B Stefanidis  4 , Mathew J Summers  4 , Mark W Bondi  5   6 , Nikki H Stricker  7   8
Affiliations
Meta-Analysis

Diagnostic Accuracy of Memory Measures in Alzheimer's Dementia and Mild Cognitive Impairment: a Systematic Review and Meta-Analysis

Gali H Weissberger et al. Neuropsychol Rev. 2017 Dec.

Abstract

With an increasing focus on biomarkers in dementia research, illustrating the role of neuropsychological assessment in detecting mild cognitive impairment (MCI) and Alzheimer's dementia (AD) is important. This systematic review and meta-analysis, conducted in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) standards, summarizes the sensitivity and specificity of memory measures in individuals with MCI and AD. Both meta-analytic and qualitative examination of AD versus healthy control (HC) studies (n = 47) revealed generally high sensitivity and specificity (≥ 80% for AD comparisons) for measures of immediate (sensitivity = 87%, specificity = 88%) and delayed memory (sensitivity = 89%, specificity = 89%), especially those involving word-list recall. Examination of MCI versus HC studies (n = 38) revealed generally lower diagnostic accuracy for both immediate (sensitivity = 72%, specificity = 81%) and delayed memory (sensitivity = 75%, specificity = 81%). Measures that differentiated AD from other conditions (n = 10 studies) yielded mixed results, with generally high sensitivity in the context of low or variable specificity. Results confirm that memory measures have high diagnostic accuracy for identification of AD, are promising but require further refinement for identification of MCI, and provide support for ongoing investigation of neuropsychological assessment as a cognitive biomarker of preclinical AD. Emphasizing diagnostic test accuracy statistics over null hypothesis testing in future studies will promote the ongoing use of neuropsychological tests as Alzheimer's disease research and clinical criteria increasingly rely upon cerebrospinal fluid (CSF) and neuroimaging biomarkers.

Keywords: Alzheimer’s disease; Memory; Meta-analysis; Mild cognitive impairment; Neuropsychological testing; Sensitivity and specificity.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Final number of studies meeting inclusionary criteria based on PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2009 standards
Fig. 2
Fig. 2
Paired forest plot AD vs HC Immediate Recall measures. AD: Alzheimer’s disease, HC: healthy controls, TP: true positive, FP: false positive, FN: false negative, TN: true negative
Fig. 3
Fig. 3
Hierarchical summary receiver-operator characteristic (SROC) curve for AD vs HC Immediate Recall measures. Conf.region = confidence region at the 95th percentile
Fig. 4
Fig. 4
Hierarchical summary receiver-operator characteristic (SROC) curve for AD versus HC for subclasses of Immediate Recall measures. Conf.region = confidence region at the 95th percentile
Fig. 5
Fig. 5
Paired forest plot AD vs HC Delayed Recall measures. AD: Alzheimer’s disease, HC: healthy controls, TP: true positive, FP: false positive, FN: false negative, TN: true negative
Fig. 6
Fig. 6
Hierarchical summary receiver-operator characteristic (SROC) curve for AD vs HC Delayed Recall measures. Conf.region = confidence region at the 95th percentile
Fig. 7
Fig. 7
Hierarchical summary receiver-operator characteristic (SROC) curve for AD vs HC for subclasses of Delayed Recall measures. Conf.region = confidence region at the 95th percentile
Fig. 8
Fig. 8
Paired forest plot MCI vs HC Immediate Recall measures. MCI: Mild Cognitive Impairment, HC: healthy controls, TP: true positive, FP: false positive, FN: false negative, TN: true negative. Conf.region = confidence region at the 95th percentile
Fig. 9
Fig. 9
Hierarchical summary receiver-operator characteristic (SROC) curve for MCI vs HC Immediate Recall measures
Fig. 10
Fig. 10
Hierarchical summary receiver-operator characteristic (SROC) curve for MCI vs HC for subclasses of Immediate Recall measures. Conf.region = confidence region at the 95th percentile
Fig. 11
Fig. 11
Paired forest plot MCI vs HC Delayed Recall measures. MCI: Mild Cognitive Impairment, HC: healthy controls, TP: true positive, FP: false positive, FN: false negative, TN: true negative
Fig. 12
Fig. 12
Hierarchical summary receiver-operator characteristic (SROC) curve for MCI vs HC Delayed Recall measures. Conf.region = confidence region at the 95th percentile
Fig. 13
Fig. 13
Hierarchical summary receiver-operator characteristic (SROC) curve for MCI vs HC for subclasses of Delayed Recall measures. Conf.region = confidence region at the 95th percentile
See this image and copyright information in PMC

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