Consistency and applicability of different brief screen instrument of cognitive function in elderly population

Abstract

Background Screening for cognitive impairment (CI) is often hampered by lack of consensus as to which screening instrument to use. The aim is to assess the consistence and applicability of different CI screening tools. Method In a cross-sectional study from October 2017 to September 2018 in 7 communities in Shanghai, China, elder (≧60) residential volunteers with no history of major cardiovascular diseases, cancers and other comorbidities known to affect cognitive functions were recruited. The participants underwent tests with 7 cognitive function screening instruments. Multivariate linear regressions were performed to test correlations between demographic characteristics, including gender, age, education, and marital status, with cognitive test scores. Mini-Mental State Examination (MMSE) score adjusted according to the correlation coefficients was used to detect CI with a cutoff of 24. Other cognitive function scores were compared between participants with and without CI. In addition, Pearson’s correlation test was used to detect association between different test scores. Results 172 participants with relatively low education levels were included. Age and education showed significant association with cognitive test scores. Using adjusted MMSE, 39.6% of participants were identified with CI, while the percentage was 87.2% when adjusted Montreal Cognitive Assessment (MoCA) with cutoff of 26 was used. Analysis of “abnormal” test scores showed that MMSE had the highest percentage of valid data (98.8%). MoCA and Isaacs test of Verbal Fluency (VF) score had correlation with most the other scores, while MMSE only significantly associated with VF and MoCA. Conclusions MMSE may still present the most applicable tools for quick screen of cognitive functions, especially when environmental conditions may interfere with participants’ attention.

Montreal Cognitive Assessment: Seeking a Single Cutoff Score May Not Be Optimal

“…is wide range of MoCA scores (i.e., 18-24) for uncertain MCI from this study reflects the wide range of MoCA cutoffs found previous studies that used certain validating criteria and ROC analysis [2][3][4][5][6][7][8][9][10][11][12]. Studies that used latent class analysis also found cutoffs within a similar range, for instance, 19-25 [27] and 19-23 [28].…”

“…Unfortunately, only 86% cases could be correctly identified as either normal or MCI [ 7 ]. Recent studies in mainland China suggested that the cutoffs for MCI were 24 in a clinical sample [ 8 ] and ranged from 18 to 25 in normative samples [ 9 – 11 ]. These studies suggested that the cutoffs were contingent upon sampling (i.e., normative versus clinical), age, education, cultural background, and validating criteria [ 12 ].…”

Depressive Symptoms and Cognitive Decline Among Chinese Rural Elderly Individuals: A Longitudinal Study With 2-Year Follow-Up

“…The MMSE was the most widely used tool for cognition assessment, with good accuracy in the detection of dementia (sensitivity and specificity were 87 and 89%, respectively) (28) as well as in MCI (sensitivity and specificity were 79.8 and 81.3% respectively) (29). A previous study concluded good applicability of MMSE as a cognitive function screen instrument in community settings of China (30). The total score of the MMSE scale is 30 points, with higher scores indicating better cognitive function.…”

Frailty in the elderly: screening possibilities in Primary Health Care

“…Initially, the elderly underwent a cognitive screening evaluation by applying the MMSE. The study defined the cut-off points according to the participant's education: illiterate, 13 points; with low or medium education, 18 points; and with a high level of education, 26 points (17)(18) . If the MMSE was below the cut-off point, the researcher interviewed the companion due to the suspicion of cognitive deficit.…”