The clinical utility of naturalistic action test in differentiating mild cognitive impairment from early dementia in memory clinic.
OBJECTIVE
This study aimed to examine the validity of the Naturalistic Action Test in differentiating Mild Cognitive Impairment from early dementia compared to clinical diagnosis and ascertain Naturalistic Action Test cut-off points.


METHODS
This was a cross-sectional study of 70 consecutive patients diagnosed with Mild Cognitive Impairment attending the memory clinic in St James's Hospital, Dublin, Ireland. Patients with a diagnosis of Mild Cognitive Impairment who attended for routine annual assessment were asked to participate in the study. The Naturalistic Action Test was carried out after the patient had completed their routine assessment in the clinic.


RESULTS
The Area under the Curve, AUC ± SE was 0.808 ± 0.058, p < 0.001 with 95% CI (0.695-0.922). There was concordance in 40 and discrepancy in 30 patients between the NAT and the gold standard consensus diagnosis (PPV 38%, NPV 96%, sensitivity 94%, specificity 46% and accuracy 59%) using cut-off point of ≥14 for normal function on Naturalistic Action Test. The difference was not related to age, sex, level of education or informant. Using the Youden index, we determined a Naturalistic Action Test cut-off score of ≥11 for Mild Cognitive Impairment in our study (PPV 50%, NPV 91%, sensitivity 78%, specificity 73% and accuracy of 74%). There was discrepancy in 18 patients using the new cut-off point (≥11 for Mild Cognitive Impairment vs ≤10 for dementia).


CONCLUSIONS
The Naturalistic Action Test is a useful tool that can increase diagnostic accuracy in differentiating Mild Cognitive Impairment from early dementia.
Memory Clinic, Mercers Institute of Research on Aging, St James Hospital, Dublin, Ireland.
Irene
I
Bruce
Memory Clinic, Mercers Institute of Research on Aging, St James Hospital, Dublin, Ireland.|Medicine for the Elderly Directorate, St James Hospital, Dublin, Ireland.
Ontefetse
O
Ntlholang
Memory Clinic, Mercers Institute of Research on Aging, St James Hospital, Dublin, Ireland.
Lisa
L
Crosby
Memory Clinic, Mercers Institute of Research on Aging, St James Hospital, Dublin, Ireland.|Medicine for the Elderly Directorate, St James Hospital, Dublin, Ireland.
Conal
C
Cunningham
Memory Clinic, Mercers Institute of Research on Aging, St James Hospital, Dublin, Ireland.|Old Age Psychiatry, Trinity College Dublin, Dublin, Ireland.
Brian
B
Lawlor
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D060825:Cognitive Dysfunction / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000592:standards*; D009660:Northern Ireland; D011569:Psychiatric Status Rating Scales / Q000592:standards; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
dementia; informant; mild cognitive impairment; mood disorders; naturalistic action test