Receiver Operating Characteristic Analysis for Validating EEG Sleep Discrimination of Elderly Depressed and Demented Patients

Abstract

Receiver operating characteristic analysis is a useful tool in validating a diagnostic marker. This technique was applied to a discriminant function model using selected electroencephalographic sleep measures (sleep maintenance, percentage of rapid-eye-movement sleep, and percentage of indeterminate non-rapid-eye-movement sleep) in elderly patients with major depression or dementia of the Alzheimer type. The diagnostic model correctly classified 79.8% of elderly depressed and demented patients. The area under the curve was 0.86, statistically different from 0.5, which would be expected by chance (P < .0001) and indicating good predictive power of the model. A logistic regression analysis demonstrated the reliability and stability of the diagnostic equation. (J Geriatr Psychiatry Neurol 1991;4:30-33).

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References

Swets JA , Pickett RM : Evaluation of Diagnostic Systems: Methods From Signal Detection Theory . New York, Academic Press, 1982.

Swets JA : Measuring the accuracy of diagnostic systems. Science 1988;240:1285-1293.

Swets JA : Indices of discrimination or diagnostic accuracy: Their ROC's and implied models. Psychobiol Bull 1986;99:100-117.

Murphy JM , Berwick DM , Weinstein MC , et al: Performance of screening and diagnostic tests. Arch Gen Psychiatry 1987;44:550-555.

Mossman D. , Somoza E. : Assessing improvements in the dexamethasone suppression test using receiver operating characteristic analysis. Biol Psychiatry 1989;25:159-173.

Giles DE , Roffwarg HP , Rush AJ , Guzick DS : Age-adjusted threshold values for reduced REM latency in unipolar depression using ROC analysis. Biol Psychiatry 1990;27:841-853.

Slap GB , Connor JL , Wigton RS , Schwartz JS : Validation of a model to identify young patients for lymph node biopsy . JAMA 1986;255:2768-2773.

Reynolds CF , Kupfer DJ , Houck PR , et al: Reliable discrimination of elderly depressed and demented patients by electroencephalographic sleep data. Arch Gen Psychiatry 1988 ;45:258-264.

American Psychiatric Association, Committee on Nomenclature and Statistics : Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. Washington, DC, American Psychiatric Association, 1980.

10.

Spitzer R. , Endicott J. , Robins E. : Research diagnostic criteria: Rationale and reliability. Arch Gen Psychiatry 1978;35:773-782.

11.

Hamilton M. : Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967;6:278-296.

12.

Blessed G. , Tomlinson BE , Roth M. : The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 1968;114:797-811.

13.

Folstein MF , Folstein SE , McHugh PR : Mini-mental state: A practical method for rating the cognitive state of patients for the clinician . J Psychiatr Res 1975;11:189-198.

14.

Rosen WG , Terry RD , Fuld PA , et al: Pathological verification of ischemia score in differentiation of dementias. Ann Neurol 1980;7:486-488.

15.

Metz CE , Kronman HB : Statistical significance tests for binormal ROC curves. J Math Psychol 1980;22:218-243.

16.

Dorfman DD , Alf E. Jr: Maximum likelihood estimation of parameters of signal detection theory—A direct solution. Psychometrika 1968;33:117-124.

17.

Metz CF , Shen J. , Wang P. , Kronman HB : LABROC4 Program. Chicago, University of Chicago, 1989.

18.

Lusted LB : Decision-making studies in patient management. N Engl J Med 1971;284:416-423.

19.

Metz CE : Basic principles of ROC analysis. Semin Nucl Med 1978;8:283-298.

20.

Halperin M. , Blackwelder WC , Verter JI : Estimation of the multivariate logistic risk function: A comparison of the discriminant function and maximum likelihood approaches. J Chronic Dis 1971;24:125-158.