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Title: In-Out-Test: A New Paradigm for Sorting the Wheat from the Chaff in Prodromal Alzheimer's Disease
Authors: Torrealba, Eduardo
García Morales, Pilar 
Cejudo, Juan Carlos
Diaz, Mario 
Rodríguez Esparragón, Francisco Javier 
Fabre, Oscar
Mesa-Herrera, Fátima
Marin, Raquel
Sánchez-García, Florentino
Rodríguez Pérez, Aurelio 
Gramunt, Nina
UNESCO Clasification: 3205 Medicina interna
320507 Neurología
Keywords: Alzheimer’s disease
Early diagnosis, et al
Issue Date: 2019
Journal: Journal of Alzheimer's Disease 
Abstract: Background: Assessment of hippocampal amnesia is helpful to distinguish between normal cognition and mild cognitive impairment (MCI), but not for identifying converters to dementia. Here biomarkers are useful but novel neuropsychological approaches are needed in their absence. The In-out-test assesses episodic memory using a new paradigm hypothesized to avoid reliance on executive function, which may compensate for damaged memory networks.Objective: To assess the validity of the In-out-test in identifying prodromal Alzheimer's disease (PAD) in a clinical setting, by comparing this to the Free and Cued Selective Reminding Test (FCSRT) and cerebrospinal fluid biomarkers.Methods: A cross-sectional study of 32 cognitively healthy, 32 MCI, and 30 progressive dementia subjects. All participants were given both the In-out-test and the FCSRT; 40 of them also received a lumbar puncture.Results: Internal consistency was demonstrated using Cronbach Alpha (r= 0.81) and Inter-rater reliability with Kappa (k= 0.94). Intraclass correlation (ICC) for test-retest reliability: r= 0.57 (p = 0.57). ICC between the In-out-test and FCSRT r= 0.87 (p = 0.001). ICC between the In-out-test and A beta(42) and P-tau/A beta(42) for controls: 0.73 and 0.75, respectively; P-tau for MCI: 0.77 and total sample: 0.70; A beta(42) for dementia: 0.71. All ICC measures between FCSRT and biomarkers were <= 0.264. AD diagnosis: In-out-test k = 0.71; FCSRT k = 0.49. PAD diagnosis (N = 35): In-out-test k = 0.69; FCSRT k = 0.44.Conclusions: The In-out-test detected prodromal AD with a higher degree of accuracy than a conventional hippocampal-based memory test. These results suggest that this new paradigm could be of value in clinical settings, predicting which patients with MCI will go on to develop AD.
ISSN: 1387-2877
DOI: 10.3233/JAD-171007
Source: Journal of Alzheimer's Disease [ISSN 1387-2877], v. 67 (1), p. 265-277
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