Diagnostic performance of a combination of Mini-Mental State Examination and Clock Drawing Test in detecting Alzheimer’s disease

Abstract

ObjectiveBecause of the growing need for quick cognitive screening tests to distinguish Alzheimer’s disease (AD) from mild cognitive impairment (MCI), we compare the diagnostic performance of a combination of the Mini-Mental State Examination (MMSE) and a Clock Drawing Test (CDT) to the Japanese version of the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-J cog) in differentiating between patients with AD, patients with MCI, and healthy controls (HC).MethodsData from 146 subjects with AD and 60 subjects with MCI, as well as 49 HC, was retrospectively analyzed. We used logistic regression analysis with diagnosis as dependent variables and scores of the MMSE, the CDT-command, and the CDT-copy as independent variables, and receiver operating characteristic analysis to distinguish patients with AD from patients with MCI or HC.ResultsWhen patients with AD were compared to HC, the independent predictors of AD were scores on the MMSE and the CDT-command. This combination was more sensitive than the MMSE alone and has nearly the same sensitivity and specificity as the ADAS-J cog. When patients with AD were compared to patients with MCI, the independent predictors were the MMSE and the CDT-copy. This combination was more sensitive and specific than the MMSE alone and was almost as sensitive and specific as the ADAS-J cog.ConclusionThe combination of the MMSE and the CDT could be a powerful screening tool for differentiating between patients with AD, patients with MCI, and HC. Its sensitivity and specificity are comparable to ADAS-J cog, which takes more time.

Memory Alteration Test to Detect Amnestic Mild Cognitive Impairment and Early Alzheimer’s Dementia in Population with Low Educational Level

“…In our sample, MMSE and CDT showed a suboptimal performance for discriminating between aMCI and healthy controls. This findings contrasts with previous studies, which found an AUC values higher than 0.80 and 0.70 with the use of MMSE and CDT, respectively (Cacho et al, 2010 ; Kato et al, 2013 ). However, a brazilian study showed a low performance of these tests (0.63 and 0.59, respectively; Ladeira et al, 2009 ).…”

Detecting dementia in patients with normal neuropsychological screening by Short Smell Test and Palmo-Mental Reflex Test: an observational study

“…As far as we can determine, this was the first study to combine these two neurological tests with neuropsychological screening by the GP. Studies such as by Kato Y et al [ 8 ] described the combination of MMSE and CDT as a powerful screening tool with high sensitivity and specificity (89.4 vs. 83.9 %). Kato’s study is one of the few studies to examine the tests in combination in a sample of hospitalized patients.…”

“…Studies show that the rate at which these tests fail to identify dementia patients is variable (MMSE 3 %–26 %, depending on the cut-off [ 5 , 6 ]; CDT alone 25 %) [ 7 ]. Combining MMSE (cut off ≤24/30 points, which is very low) and CDT returned a false negative rate of 9 % [ 8 ]. If GPs can use easy and practical neurological tests to detect dementia, they may be able to more accurately judge whether a patient needs further investigation.…”

Frailty Index and Cognitive Decline in Alzheimer's Disease: Data from the Impact of Cholinergic Treatment USe Study

“…The MMSE is a commonly used psychometric screening assessment of cognitive function and has a maximum score of 30 points grouped into seven categories, with lower scores indicating greater cognitive impairment . The ADAS‐Cog is widely used to assess cognitive function in individuals with AD in clinical practice and research .…”