Cognitive Tests to Detect Dementia

Abstract

IMPORTANCE Dementia is a global public health problem. The Mini-Mental State Examination (MMSE) is a proprietary instrument for detecting dementia, but many other tests are also available.OBJECTIVE To evaluate the diagnostic performance of all cognitive tests for the detection of dementia.DATA SOURCES Literature searches were performed on the list of dementia screening tests in MEDLINE, EMBASE, and PsychoINFO from the earliest available dates stated in the individual databases until September 1, 2014. Because Google Scholar searches literature with a combined ranking algorithm on citation counts and keywords in each article, our literature search was extended to Google Scholar with individual test names and dementia screening as a supplementary search.STUDY SELECTION Studies were eligible if participants were interviewed face to face with respective screening tests, and findings were compared with criterion standard diagnostic criteria for dementia. Bivariate random-effects models were used, and the area under the summary receiver-operating characteristic curve was used to present the overall performance.MAIN OUTCOMES AND MEASURES Sensitivity, specificity, and positive and negative likelihood ratios were the main outcomes.RESULTS Eleven screening tests were identified among 149 studies with more than 49 000 participants. Most studies used the MMSE (n = 102) and included 10 263 patients with dementia. The combined sensitivity and specificity for detection of dementia were 0.81 (95% CI, 0.78-0.84) and 0.89 (95% CI, 0.87-0.91), respectively. Among the other 10 tests, the Mini-Cog test and Addenbrooke's Cognitive Examination-Revised (ACE-R) had the best diagnostic performances, which were comparable to that of the MMSE (Mini-Cog, 0.91 sensitivity and 0.86 specificity; ACE-R, 0.92 sensitivity and 0.89 specificity). Subgroup analysis revealed that only the Montreal Cognitive Assessment had comparable performance to the MMSE on detection of mild cognitive impairment with 0.89 sensitivity and 0.75 specificity. CONCLUSIONS AND RELEVANCEBesides the MMSE, there are many other tests with comparable diagnostic performance for detecting dementia. The Mini-Cog test and the ACE-R are the best alternative screening tests for dementia, and the Montreal Cognitive Assessment is the best alternative for mild cognitive impairment.

Preoperative Cognitive Stratification of Older Elective Surgical Patients: A Cross-Sectional Study

“…Both tests are brief and were designed for primary care but have been used in surgical settings, involve clock drawing, have minimal education and cultural/language bias, and are validated in community samples against standardized cognitive measures. (13–22) Study staff administered the test in a quiet examination room in the clinic. The Mini-Cog involves a 3-item recall test for memory and a clock drawing test that serves as a distractor; it tests visuospatial representation, recall, and executive function and has a sensitivity and specificity for the detection of dementia of 0.91 and 0.86, respectively.…”

“…The Mini-Cog involves a 3-item recall test for memory and a clock drawing test that serves as a distractor; it tests visuospatial representation, recall, and executive function and has a sensitivity and specificity for the detection of dementia of 0.91 and 0.86, respectively. (11,13,14,22,23) The ClB also involves a clock drawing test but includes no formal item recall; instead, it tests working memory and planning/organization. (16,19) The CIB also correlates with other tests of cognitive function.…”

Comparative Diagnostic Accuracy of the ACE-III, MIS, MMSE, MoCA, and RUDAS for Screening of Alzheimer Disease

“…There have been several cognitive tests which have been developed and validated to support the diagnosis of dementia. The Mini-Mental State Examination (MMSE) has been considered the gold standard [2] but has incurred criticism because of an underrepresentation of memory and executive functioning tasks, ceiling and floor effects, influence of education, and restriction of use by copyright, amongst other points of criticism [3]. Therefore, new screening tests have subsequently been developed [4,5].…”

Screening of Cognitive Impairment in the Dialysis Population: A Scoping Review

“…Since the BEC 96 is hardly known outside the French scientific community, its usefulness as a screening instrument was difficult to assess when only English-language articles were reviewed. The MoCA and the MMSE are brief tests, taking <10 min to administer, whereas the 3MS is a more detailed test [60]. …”