Diagnostic test accuracy of cognitive screeners in older people

Wojtowicz, Alex; Larner, A. J.

doi:10.1002/pnp.457

Cited by 23 publications

(8 citation statements)

References 14 publications

(17 reference statements)

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“…The findings confirmed those of the preliminary report, (11) and greatly extended these, by examining two MACE cut-offs, two age cut-offs, and more summary measures in a larger patient cohort. The results suggest that in clinical practice either MACE cut-off may be chosen, dependent upon exact clinician requirements, since both increase PPV.…”

Section: Discussionsupporting

confidence: 85%

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Mini-Addenbrooke’s Cognitive Examination (MACE): a Useful Cognitive Screening Instrument in Older People?

Larner

2020

Can Geri J

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Background The Mini-Addenbrooke’s Cognitive Examination (MACE) is a recently described brief cognitive screening instrument. Objective To examine the test accuracy of MACE for the identification of dementia and mild cognitive impairment (MCI) in a cohort of older patients assessed in a neurology-led dedicated cognitive disorders clinic. Methods Cross-sectional assessment of consecutive patients with MACE was performed independent of the reference standard diagnosis based on clinical interview of patient and, where possible, informant and structural brain imaging, and applying standard clinical diagnostic criteria for dementia and MCI. Various test accuracy metrics were examined at two MACE cut-offs ( ≤ 25/30 and ≤ 21/30), comparing the whole patient cohort with those aged ≥ 65 or ≥ 75 years, hence at different disease prevalences. Results Dependent upon the chosen cut-off, MACE was either very sensitive or very specific for the identification of any cognitive impairment in the older patient cohorts with increased disease prevalence. However, at both cut-offs the positive predictive values and post-test odds increased in the older patient cohorts. At the more sensitive cut-off, improvements in some new unitary test metrics were also seen. Conclusion MACE is a valid instrument for identification of cognitive impairment in older people. Test accuracy metrics may differ with disease prevalence.

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Section: Discussionsupporting

confidence: 85%

“…Some preliminary (two-year) data from this study have appeared as part of a broader study examining the utility of various CSIs in older patients (aged ≥ 65 years) seen in a dedicated cognitive disorders clinic. (11)…”

Section: Mini-addenbrooke's Cognitive Examination (Mace): a Useful Cognitive Screening Instrument In Older People?mentioning

confidence: 99%

Mini-Addenbrooke’s Cognitive Examination (MACE): a Useful Cognitive Screening Instrument in Older People?

Larner

2020

Can Geri J

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“…Generalization of the current findings to other settings may not therefore be possible, although an examination in an older patient subgroup from this clinic showed better metrics for MACE than in the sample as a whole [13]. The absence of data on education precluded examination of its effect on MACE performance.…”

Section: Discussionmentioning

confidence: 96%

“…In a nephrology clinic cohort of patients with chronic kidney disease and diabetes (n = 112), the sensitivity and specificity for a dementia diagnosis were 0.96 and 0.84, respectively, at the cut point < 25/30 [6]. Studies in a dedicated cognitive disorders clinic have suggested superiority of the MACE to MMSE [7][8][9] and single-item cognitive screening questions [10] and equivalence to the Montreal Cognitive Assessment (MoCA) [9,11,12], and a better performance in those aged > 65 years, with a higher prevalence of cognitive impairment [13]. In a study of patients with mild AD (n = 92) and healthy controls (n = 68), MACE had an area under the receiver operating characteristic (AUC ROC) curve of 0.939, which was superior to ACE-III (0.897), Rowland Universal Dementia Assessment Scale (0.889), MMSE (0.874), Memory Impairment Screen (0.866), and MoCA (0.856) [14].…”

Section: Introductionmentioning

confidence: 99%

MACE for the Diagnosis of Dementia and MCI: 3-Year Pragmatic Diagnostic Test Accuracy Study

Williamson¹,

Larner²

2018

Dement Geriatr Cogn Disord

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Background/Aims: The Mini-Addenbrooke’s Cognitive Examination (MACE) is a relatively new short cognitive screening instrument for the detection of patients with dementia and mild cognitive impairment (MCI). Few studies of the MACE have been reported hitherto. The aim of this study was to undertake a pragmatic diagnostic test accuracy study of MACE in a large cohort of patients seen in a dedicated cognitive disorders clinic. Methods: MACE was administered to consecutive patients referred to a neurology-led Cognitive Function Clinic over the course of 3 years to assess its performance for the diagnosis of dementia and MCI using various test metrics. Results: In a cohort of 599 patients, the prevalence of dementia and MCI by criterion diagnosis was 0.17 and 0.29, respectively. MACE had a high sensitivity (> 0.9) and negative predictive values (> 0.8) with large effect sizes (Cohen’s d > 1) for the diagnosis of both dementia and MCI but a low specificity (< 0.5) and positive predictive values (≤0.5). Conclusion: MACE is an acceptable test for the assessment of cognitive complaints in a secondary care setting with good metrics for identifying cases of both dementia and MCI.

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“…The results of the current study replicate prior findings demonstrating the utility of the MoCA total score as an initial screen for MCI and AD. [1, 11–14] The total score had large effect sizes, and these values increased in distinguishing MCI vs. Cognitively Normal (d=0.83), AD vs. MCI (d=1.60), and AD vs. Cognitively Normal (d=2.38) groups. The large effect sizes in the current study, based on a research sample screened for MCI and AD, replicates the findings in clinic samples.…”

Section: Discussionmentioning

confidence: 99%

Incremental Validity of Montreal Cognitive Assessment Index Scores in Mild Cognitive Impairment and Alzheimer Disease

Goldstein¹,

Milloy²,

Loring³

2018

Dement Geriatr Cogn Disord

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Background/Aims: The aim of this paper was to evaluate the incremental validity of the Montreal Cognitive Assessment (MoCA) index scores and the MoCA total score in differentiating individuals with normal cognition versus mild cognitive impairment (MCI) or Alzheimer disease (AD). Methods: Effect sizes were calculated for Alzheimer’s Disease Neuroimaging Initiative research participants with normal cognition (n = 295), MCI (n = 471), or AD (n = 150). Results: Effect sizes for the total score were large (> 0.80) and exceeded the index scores in differentiating those with MCI versus normal cognition, MCI versus AD, and AD versus normal cognition. A combined score incorporating the Memory, Executive, and Orientation indexes also improved incremental validity for all 3 group comparisons. Conclusion: Administration of the entire MoCA is more informative than the index scores, especially in distinguishing normal cognition versus MCI. A combined score has stronger incremental validity than the individual index scores.

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Diagnostic test accuracy of cognitive screeners in older people

Cited by 23 publications

References 14 publications

Mini-Addenbrooke’s Cognitive Examination (MACE): a Useful Cognitive Screening Instrument in Older People?

Mini-Addenbrooke’s Cognitive Examination (MACE): a Useful Cognitive Screening Instrument in Older People?

MACE for the Diagnosis of Dementia and MCI: 3-Year Pragmatic Diagnostic Test Accuracy Study

Incremental Validity of Montreal Cognitive Assessment Index Scores in Mild Cognitive Impairment and Alzheimer Disease

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