Validity of screening instruments for the detection of dementia and mild cognitive impairment in hospital inpatients: A systematic review of diagnostic accuracy studies

Abstract

Introduction As the population ages, Alzheimer's disease and other subtypes of dementia are becoming increasingly prevalent. However, in recent years, diagnosis has often been delayed or not made at all. Thus, improving the rate of diagnosis has become an integral part of national dementia strategies. Although screening for dementia remains controversial, the case is strong for screening for dementia and other forms of cognitive impairment in hospital inpatients. For this reason, the objective of this systematic review was to provide clinicians, who wish to implement screening, an up-to-date choice of cognitive tests with the most extensive evidence base for the use in elective hospital inpatients. Methods For this systematic review, PubMed, PsycINFO and Cochrane Library were searched by using a multi-concept search strategy. The databases were accessed on April 10, 2019. All cross-sectional studies that utilized brief, multi-domain cognitive tests as index test and a reference standard diagnosis of dementia or mild cognitive impairment as comparator were included. Only studies conducted in the hospital setting, sampling from unselected, elective inpatients older than 64 were considered. Results Six studies met the inclusion criteria, with a total of 2112 participants. Diagnostic accuracy data for the Six-Item Cognitive Impairment Test, Cognitive Performance Scale, Clock-Drawing Test, Mini-Mental Status Examination, and Time & Change test were extracted and descriptively analyzed. Clinical and methodological heterogeneity between the studies precluded performing a meta-analysis. Discussion This review found only a small number of instruments and was not able to recommend a single best instrument for use in a hospital setting. Although it was not possible to estimate the pooled operating characteristics, the included description of instrument characteristics, the descriptive analysis of performance measures, and the critical evaluation of the reporting studies may contribute to clinician's choice of the screening instrument that fits best their purpose.

Is Barthel Index Suitable for Assessing Activities of Daily Living in Patients With Dementia?

“…Observation of patients' ADL ability and BPSD by trained research assistants may help to overcome this limitation in future studies. Third, the MMSE is a norm-based psychometric measure which compares individual functioning to a reference group, therefore, confounding factors, such as education level and floor effect, might impact this normbased measures (30). Adjusting for confounding should be taken to improve diagnostic accuracy in our future research, although 75.6% of the subjects were at moderate to severe stage of dementia in this study.…”

“…The MMSE has established internal consistency (Cronbach's a > 0.7), test-retest reliability (ICC 0.95), construct validity, and criterion validity (28,29). Using the common cut-off value of <24, a recent systematic review summarized that sensitivity (0.75-0.88) and specificity (0.73-0.94) of the MMSE for detecting all-cause dementia in hospital samples were acceptable (30).…”

Biomarker Testing: Piercing the Fog of Alzheimer’s and Related Dementia

“…The 2018 research framework of the NIA-AA [12] clearly considered AD no longer a clinical diagnosis but a biological diagnosis, irrespective of the presence and severity of symptoms! Effective early intervention requires the identification of early-stage patients, by screening patients for signs of early-stage memory loss or MCI, then testing for the AD pathology or other dementia [13].…”

Dementia diagnostics in primary care : with a focus on cognitive testing

“…Perhaps one way of working with diagnostic dementia instruments for GPs is to choose between several available instruments depending on the patient's symptoms. A recent review of validity of screening instruments for the detection of dementia and mild cognitive impairment in hospital inpatients was not able to recommend a single best instrument for use in the hospital setting (164). In primary care, we have a risk of under-diagnosis with the older instrument MMSE and a possible risk of over-diagnosis with newer MCI profiled instruments such as MoCA and different quick MCI screening tests.…”