Identification of Hasegawa Dementia Scale-Revised Cutoff Scores Associated With Mini-Mental State Examination Thresholds for Anti-Amyloid β Therapies in Patients With Amnesia.

backgroundThis study aimed to evaluate Hasegawa Dementia Scale-Revised (HDS-R) cutoff scores that correspond to Mini-Mental State Examination (MMSE) thresholds for identifying candidates for anti-amyloid β (Aβ) therapies. Additionally, we conducted exploratory analyses to examine the cognitive subdomains associated with Aβ status.

methodsThis retrospective cross-sectional study included consecutive patients with amnesia who underwent neuropsychological examinations and Aβ assessment through cerebrospinal fluid analysis or positron emission tomography. Diagnostic accuracy for MMSE thresholds (≥ 20, ≥ 22 and ≥ 24) was assessed, and two HDS-R cutoffs (high-sensitivity, high-specificity) were determined for each threshold. We examined differences in cognitive subdomains between Aβ-positive and Aβ-negative patients with MMSE score ≥ 20.

resultsOf 234 patients, 143 (61.1%) were Aβ-positive. The area under the receiver operating characteristic curve for predicting MMSE score ≥ 20, ≥ 22 and ≥ 24 was 0.92, 0.90 and 0.91, respectively. High-sensitivity cutoffs, defined as scores that maximised specificity while maintaining sensitivity ≥ 80%, were HDS-R score ≥ 16, ≥ 17 and ≥ 18. Conversely, high-specificity cutoffs, defined as scores that maximised sensitivity while maintaining specificity ≥ 80%, were HDS-R score ≥ 19, ≥ 20 and ≥ 21, respectively. Subdomain analysis of MMSE and HDS-R showed Aβ-positive patients had lower scores in delayed recall and higher scores in calculation than Aβ-negative patients (all p < 0.01). In HDS-R subdomains, visual memory scores were also lower in Aβ-positive patients than in Aβ-negative patients (p < 0.01).

conclusionsThe identified HDS-R cutoff scores were associated with MMSE-defined cognitive thresholds and may serve as a potential reference for identifying patients who could be eligible for anti-Aβ therapies. The cognitive profile observed in Aβ-positive patients was characterised by deficits in delayed recall and in visual memory and by relatively preserved calculation ability, suggesting a selective vulnerability pattern in early Alzheimer's disease.