Sex-specific norms for verbal memory tests may improve diagnostic accuracy of amnestic MCI

Alzheimer's Disease Neuroimaging Initiative

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To examine whether the use of sex-specific norms and cut scores to identify memory impairment improves diagnostic accuracy of amnestic mild cognitive impairment (aMCI) compared to non-sex-specific (typical) norms/cut scores given the female advantage in verbal memory. METHODS: We calculated sex-specific and typical norms/cut scores (age and education specific) for impairment on the Rey Auditory Verbal Learning Test in the Mayo Clinic Study of Aging. Norms/cut scores were applied to 453 women and 532 men from the Alzheimer's Disease Neuroimaging Initiative. We compared sex differences in rates of aMCI (Jak/Bondi criteria) for sex-specific vs typical norms/cut scores. Using sex-specific cut scores as the true condition and typical cut scores as the predicted condition, we categorized participants as true positives (TPs), false positives (FPs), true negative (TNs), or false negative (FNs). In cross-sectional analyses within sex, we compared positivity rates of CSF hyperphosphorylated tau/β-amyloid (Aβ) and cortical Aβ deposition ([18F]AV45 PET) and APOE ε4 frequency among diagnostic comparison groups. RESULTS: The frequency of aMCI was higher in men when using typical norms/cut scores. Using sex-adjusted norms/cut scores led to the identification of 10% FNs (missed aMCI cases) among women and 10% FPs among men. Biomarker analyses supported the hypothesis that sex-specific diagnostic criteria improves diagnostic accuracy. Biomarkers rates were higher in FNs vs TNs and similar in FNs and TPs. Biomarker rates were lower in FPs vs TPs and similar between FPs and TNs. CONCLUSION: Results suggest that non-sex-specific aMCI diagnostic criteria led to a 20% diagnostic error rate. Accounting for sex differences in verbal memory performance may improve aMCI classification.

Original languageEnglish (US)
Pages (from-to)e1881-e1889
JournalNeurology
Volume93
Issue number20
DOIs
StatePublished - Nov 12 2019

Fingerprint

Biomarkers
Sex Characteristics
Verbal Learning
Diagnostic Errors
Amyloid
Neuroimaging
Cognitive Dysfunction
Alzheimer Disease
Cross-Sectional Studies
Education

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Sex-specific norms for verbal memory tests may improve diagnostic accuracy of amnestic MCI. / Alzheimer's Disease Neuroimaging Initiative.

In: Neurology, Vol. 93, No. 20, 12.11.2019, p. e1881-e1889.

Research output: Contribution to journalArticle

Alzheimer's Disease Neuroimaging Initiative. / Sex-specific norms for verbal memory tests may improve diagnostic accuracy of amnestic MCI. In: Neurology. 2019 ; Vol. 93, No. 20. pp. e1881-e1889.
@article{153a57fa9bfb4516af7ba6cecb7f1d08,
title = "Sex-specific norms for verbal memory tests may improve diagnostic accuracy of amnestic MCI",
abstract = "OBJECTIVE: To examine whether the use of sex-specific norms and cut scores to identify memory impairment improves diagnostic accuracy of amnestic mild cognitive impairment (aMCI) compared to non-sex-specific (typical) norms/cut scores given the female advantage in verbal memory. METHODS: We calculated sex-specific and typical norms/cut scores (age and education specific) for impairment on the Rey Auditory Verbal Learning Test in the Mayo Clinic Study of Aging. Norms/cut scores were applied to 453 women and 532 men from the Alzheimer's Disease Neuroimaging Initiative. We compared sex differences in rates of aMCI (Jak/Bondi criteria) for sex-specific vs typical norms/cut scores. Using sex-specific cut scores as the true condition and typical cut scores as the predicted condition, we categorized participants as true positives (TPs), false positives (FPs), true negative (TNs), or false negative (FNs). In cross-sectional analyses within sex, we compared positivity rates of CSF hyperphosphorylated tau/β-amyloid (Aβ) and cortical Aβ deposition ([18F]AV45 PET) and APOE ε4 frequency among diagnostic comparison groups. RESULTS: The frequency of aMCI was higher in men when using typical norms/cut scores. Using sex-adjusted norms/cut scores led to the identification of 10{\%} FNs (missed aMCI cases) among women and 10{\%} FPs among men. Biomarker analyses supported the hypothesis that sex-specific diagnostic criteria improves diagnostic accuracy. Biomarkers rates were higher in FNs vs TNs and similar in FNs and TPs. Biomarker rates were lower in FPs vs TPs and similar between FPs and TNs. CONCLUSION: Results suggest that non-sex-specific aMCI diagnostic criteria led to a 20{\%} diagnostic error rate. Accounting for sex differences in verbal memory performance may improve aMCI classification.",
author = "{Alzheimer's Disease Neuroimaging Initiative} and Sundermann, {Erin E.} and Pauline Maki and Anat Biegon and Lipton, {Richard B.} and Mielke, {Michelle M.} and Mary Machulda and Bondi, {Mark W.}",
year = "2019",
month = "11",
day = "12",
doi = "10.1212/WNL.0000000000008467",
language = "English (US)",
volume = "93",
pages = "e1881--e1889",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "20",

}

TY - JOUR

T1 - Sex-specific norms for verbal memory tests may improve diagnostic accuracy of amnestic MCI

AU - Alzheimer's Disease Neuroimaging Initiative

AU - Sundermann, Erin E.

AU - Maki, Pauline

AU - Biegon, Anat

AU - Lipton, Richard B.

AU - Mielke, Michelle M.

AU - Machulda, Mary

AU - Bondi, Mark W.

PY - 2019/11/12

Y1 - 2019/11/12

N2 - OBJECTIVE: To examine whether the use of sex-specific norms and cut scores to identify memory impairment improves diagnostic accuracy of amnestic mild cognitive impairment (aMCI) compared to non-sex-specific (typical) norms/cut scores given the female advantage in verbal memory. METHODS: We calculated sex-specific and typical norms/cut scores (age and education specific) for impairment on the Rey Auditory Verbal Learning Test in the Mayo Clinic Study of Aging. Norms/cut scores were applied to 453 women and 532 men from the Alzheimer's Disease Neuroimaging Initiative. We compared sex differences in rates of aMCI (Jak/Bondi criteria) for sex-specific vs typical norms/cut scores. Using sex-specific cut scores as the true condition and typical cut scores as the predicted condition, we categorized participants as true positives (TPs), false positives (FPs), true negative (TNs), or false negative (FNs). In cross-sectional analyses within sex, we compared positivity rates of CSF hyperphosphorylated tau/β-amyloid (Aβ) and cortical Aβ deposition ([18F]AV45 PET) and APOE ε4 frequency among diagnostic comparison groups. RESULTS: The frequency of aMCI was higher in men when using typical norms/cut scores. Using sex-adjusted norms/cut scores led to the identification of 10% FNs (missed aMCI cases) among women and 10% FPs among men. Biomarker analyses supported the hypothesis that sex-specific diagnostic criteria improves diagnostic accuracy. Biomarkers rates were higher in FNs vs TNs and similar in FNs and TPs. Biomarker rates were lower in FPs vs TPs and similar between FPs and TNs. CONCLUSION: Results suggest that non-sex-specific aMCI diagnostic criteria led to a 20% diagnostic error rate. Accounting for sex differences in verbal memory performance may improve aMCI classification.

AB - OBJECTIVE: To examine whether the use of sex-specific norms and cut scores to identify memory impairment improves diagnostic accuracy of amnestic mild cognitive impairment (aMCI) compared to non-sex-specific (typical) norms/cut scores given the female advantage in verbal memory. METHODS: We calculated sex-specific and typical norms/cut scores (age and education specific) for impairment on the Rey Auditory Verbal Learning Test in the Mayo Clinic Study of Aging. Norms/cut scores were applied to 453 women and 532 men from the Alzheimer's Disease Neuroimaging Initiative. We compared sex differences in rates of aMCI (Jak/Bondi criteria) for sex-specific vs typical norms/cut scores. Using sex-specific cut scores as the true condition and typical cut scores as the predicted condition, we categorized participants as true positives (TPs), false positives (FPs), true negative (TNs), or false negative (FNs). In cross-sectional analyses within sex, we compared positivity rates of CSF hyperphosphorylated tau/β-amyloid (Aβ) and cortical Aβ deposition ([18F]AV45 PET) and APOE ε4 frequency among diagnostic comparison groups. RESULTS: The frequency of aMCI was higher in men when using typical norms/cut scores. Using sex-adjusted norms/cut scores led to the identification of 10% FNs (missed aMCI cases) among women and 10% FPs among men. Biomarker analyses supported the hypothesis that sex-specific diagnostic criteria improves diagnostic accuracy. Biomarkers rates were higher in FNs vs TNs and similar in FNs and TPs. Biomarker rates were lower in FPs vs TPs and similar between FPs and TNs. CONCLUSION: Results suggest that non-sex-specific aMCI diagnostic criteria led to a 20% diagnostic error rate. Accounting for sex differences in verbal memory performance may improve aMCI classification.

UR - http://www.scopus.com/inward/record.url?scp=85074874195&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074874195&partnerID=8YFLogxK

U2 - 10.1212/WNL.0000000000008467

DO - 10.1212/WNL.0000000000008467

M3 - Article

C2 - 31597708

AN - SCOPUS:85074874195

VL - 93

SP - e1881-e1889

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 20

ER -