Abstract

The Hopkins Verbal Learning Test (HVLT) and the Mini-Mental State Examination (MMSE) were administered to 323 non-demented elderly and 70 individuals who meet DSM-IV criteria for dementia in order to compare the validity of these two measures for detecting mild dementia and for the two most common dementia subtypes, Alzheimer's disease (AD) and vascular dementia (VaD). The study was conducted in an elderly, ethnically diverse community-dwelling population. Sensitivity, specificity, positive and negative predictive values were calculated over a range of clinically relevant cut scores for each test. We analyzed the influence of age, education, reading ability and sex on test performance using logistic regression models.

When sensitivity is held constant at 0.69, the specificity for the HVLT total recall was 0.89 and the MMSE 0.82 for all dementias (P=.10). Age, sex and education did not significantly influence test performance for either test in this sample. Results were similar for AD and VaD. However, while adding a measure of reading ability to the regression models did not affect the overall dementia model, it resulted in improved specificities when combined with the MMSE for AD and combined with the HVLT for VaD. Additional tests such as reading ability can improve discrimination of dementia subtypes. The modest sensitivity of either the HVLT or the MMSE alone suggests that further neuropsychological evaluation is required to confirm dementia diagnosis.