Adapting the Hopkins Verbal Learning Test-Revised with Semantic Cues: Assessing diagnostic utility in a Spanish clinical population

Background: The Hopkins Verbal Learning Test-Revised (HVLT-R) is widely used for assessing episodic memory. In this study, we evaluated the HVLT-R with Semantic Cues (HVLT-R-SC), an adapted version incorporating semantic cues to improve diagnostic utility. The assessment was conducted in a Spanish cohort comprising cognitively unimpaired controls, individuals with multi-domain amnestic mild cognitive impairment (md-aMCI), and early Alzheimer's disease (AD). Methods: 684 participants (333 controls, 141 md-aMCI, and 210 early AD) completed the HVLT-R-SC. Effect sizes were calculated to quantify group differences, while Cronbach's alpha was used to assess the test's reliability. Receiver Operating Characteristic curve analysis was performed to assess discriminatory power, with the Area Under the Curve (AUC) summarizing classification accuracy. Sensitivity, specificity, and efficacy percentages were reported, with optimized cutoff points determined. Odds ratios quantified the association between HVLT-R-SC performance and diagnostic group classifications. Results: Significant differences were observed across all HVLT-R-SC indices among the groups. Total Delayed Recall with and without Semantic Cues exhibited the largest effect size (eta 2 = 0.69), with Total Delayed Recall with Semantic Cues demonstrating the highest diagnostic accuracy (AUC = 0.90 for differentiating md-aMCI from controls and 0.99 for distinguishing early AD from controls). Optimal cutoffs for Total Delayed Recall with Semantic Cues were 5 words for md-aMCI (sensitivity = 74%, specificity = 90%, efficacy = 85.44%) and 4 words for early AD (sensitivity = 93%, specificity = 97%, efficacy = 95.21%). Significant associations were observed between HVLT-R-SC performance and diagnostic classification, with an odds ratio of 26.04 for md-aMCI and 362.50 for early AD. Internal consistency was excellent (Cronbach's alpha = 0.95), indicating strong reliability of the HVLT-R-SC. Conclusions: The HVLT-R-SC demonstrated strong reliability and excellent diagnostic performance in identifying memory impairments. The inclusion of semantic cues improved diagnostic accuracy, provided clinically actionable cutoff points, and enhanced the test's utility, particularly for detecting md-aMCI and early AD.