A comparison of diagnostic performance of word-list and story recall tests for biomarker-determined Alzheimer’s disease

Abstract

Background: Wordlist and story recall tests are routinely employed in clinical practice for dementia diagnosis. In this study, our aim was to establish how well-standard clinical metrics compared to process scores derived from wordlist and story recall tests in predicting biomarker determined Alzheimer’s disease, as defined by CSF ptau/Aβ42 ratio. Methods: Data from 295 participants (mean age = 65 ± 9.) were drawn from the University of Wisconsin–Madison Alzheimer’s Disease Research Center (ADRC) and Wisconsin Registry for Alzheimer’s Prevention (WRAP). Rey’s Auditory Verbal Learning Test (AVLT; wordlist) and Logical Memory Test (LMT; story) data were used. Bayesian linear regression analyses were carried out with CSF ptau/Aβ42 ratio as outcome. Sensitivity analyses were carried out with logistic regressions to assess diagnosticity. Results: LMT generally outperformed AVLT. Notably, the best predictors were primacy ratio, a process score indexing loss of information learned early during test administration, and recency ratio, which tracks loss of recently learned information. Sensitivity analyses confirmed this conclusion. Conclusions: Our study shows that story recall tests may be better than wordlist tests for detection of dementia, especially when employing process scores alongside conventional clinical scores.