Determining appropriate screening tools and cut-points for cognitive impairment in an elderly Chinese sample.

Abstract

The establishment of normative data and screening cut-points for cognitive tasks is important to ensure the effective and timely detection of mild cognitive impairment (MCI) and Alzheimer's disease (AD). These need to be culturally relevant and account for known factors that impact on cognition such as age, education, and gender. In this study, 1,068 elderly Chinese residents of Shanghai completed a comprehensive series of cognitive tasks as part of a community screening study with 1027 meeting criteria for analysis, age M(SD) = 72.54 (8.40). MCI was detected in 267 individuals, AD in 50, and 710 had normal cognition. Receiver Operator Characteristic curve analysis indicated that the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) best differentiated normal cognition from MCI and AD. We present suggested cut-points to differentiate between normal cognition and MCI and AD for the total sample, and when split according to education levels, age, and gender. Trends suggest that the MoCA was better suited to detecting MCI, and the MMSE was better for detecting AD. For younger and more educated participants, only a slight impairment was necessary to meet screening criteria, while a larger impairment was necessary for older and less educated participants. Both tasks had a high negative predictive values for MCI and AD, and variable positive predictive values. The cut-points presented can be used to inform future work using the MMSE and MoCA to screen for MCI and AD in older Chinese people. (PsycINFO Database Record

[P3–284]: The Montreal Cognitive Assessment: Normative Data From a Large Swedish Population‐based Cohort

“…Consistent with previous findings, older age was associated with lower scores [11][12][13][14][15][16][17][18][31][32][33][34][35]. We found a 1.0-point difference between the youngest (65-75) and oldest (75-85) groups; other studies have reported a difference of 0.6-2.4 points between similar age groups [13,[15][16][17]31].…”

“…We found a 1.0-point difference between the youngest (65-75) and oldest (75-85) groups; other studies have reported a difference of 0.6-2.4 points between similar age groups [13,[15][16][17]31]. Lower level of education was significantly associated with lower scores, correlating with results from other studies [11][12][13][14][15][16][17][18][31][32][33][34][35]. The difference in mean score was 1.4 points between the least and highest educated groups, in agreement with the original suggested method of adding an extra point for low education (≤12 years).…”

“…Using the cut-off score from the original study, 37.3% of our normative population would have been incorrectly interpreted as cognitively impaired according to our evaluation of the population. The mean score of 26.0 (SD 2.3) was 1.0-4.2 points higher than in other normative studies [13][14][15][16][17][31][32][33], though lower than the average score of 27 for cognitively normal participants in the small original study (n = 90 healthy elderly controls). The very large normative study using data from the Dallas Heart Study (n = 2,653) included participants aged 18-85 [15].…”

Cognitive Assessment Tools for Screening Older Adults With Low Levels of Education: A Critical Review

“…Some of the studies (23,24,35,36,39,(50)(51)(52)58) assessed the prevalence of MCI and AD ranging from 1.72% (58) to 32.9% (52) and 4.2% (35) to 9% (51), respectively. The number of adults with MCI ranged from 12 (58) to 2,049 (30) and the number of adults with AD ranged from 16 (51) to 1,061 (25). Mean age of the study participants ranged from 64.5 (40) to 82 years (50).…”

“…The MoCA is a cognitive battery that includes tests sensitive to executive functions and has higher sensitivity for diagnosing MCI (24,33,68). However, MoCA scores are strongly influenced by educational background as MoCA tasks are designed for a certain level of education making it difficult to assess individuals who are either illiterate or with low levels of education (30). Therefore, a MoCA basic version (MoCA-B) was developed to include tasks designed to assess the same cognitive domain regardless of the level of education (45,60,68).…”