Abstract:

Purpose: Short screening tests are frequently used in clinical practice for dementia screening and diagnosis. The Mini Mental State Examination (MMSE) is one of the most frequently used. MMSE is known to have high sensitivity for dementia. However, MMSE is often not sufficient in the differentiation of Mild Cognitive Impairment (MCI), which is considered a transitional stage between healthy aging and dementia, and in the differential diagnosis of dementia of Alzheimer's Disease type (ADD) and MCI. Verbal fluency tests (semantic and phonemic), which can be applied in a time-limited medical settings, can be used as an alternative to MMSE or when used with MMSE higher diagnostic accuracy can be obtained for the early stages of AD and MCI. The aim of this study is to present the sensitivity, specificity and cut-off points of MMSE, semantic and phonemic fluency tests determined by ROC curve analysis. Materials and Methods: Age-education-sex matched 72 healthy individuals, 72 MCI and 72 AD dementia individuals were included in the study. MMSE, semantic and phonemic fluency tests were applied to all participants. Sensitivity and specificity values and cut-off scores of MMSE, semantic and phonemic fluency tests in distinguishing healthy, MCI and ADD individuals were obtained by ROC curve analysis. Results: ROC analyses show that all three tests can significantly discriminate between healthy, ADD and MCI individuals. It was seen that the discrimination power of the MMSE was higher than the verbal fluency tests when the areas under the ROC curve were compared. The specificity of semantic fluency was found to be higher than MMSE and phonemic fluency in distinguishing individuals with ADD and MCI. Conclusion: The findings of the study show that MMSE is stronger than semantic and phonemic fluency in distinguishing healthy individuals, but its specificity is lower than semantic fluency in distinguishing MCI and AD dementia. In order to increase the diagnostic accuracy, it may be effective to add verbal fluency tests, especially semantic fluency test, which can be applied in a short time, to clinical practice.

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