Screening and Case Finding Tools for the Detection of Dementia. Part I: Evidence-Based Meta-Analysis of Multidomain Tests

Mitchell, Alex J.; Malladi, Srinivasa

doi:10.1097/jgp.0b013e3181cdecb8

Cited by 108 publications

(51 citation statements)

References 72 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The MMSE is the most widely used cognitive screening test 35 and may remain the best screening tool for primary care clinicians to rule in or rule out a diagnosis of dementia. 40 In our study, the MMSE identified 51 while the SIS identified twice the number (114) of participants with possible cognitive impairment. Compared with the MMSE, the SIS showed good sensitivity and specificity suggesting that it may be a useful screening tool as an alternative to the MMSE locally.…”

Section: Performance Of Toolsmentioning

confidence: 94%

Screening a heterogeneous elderly South African population for cognitive impairment: the utility and performance of the Mini-Mental State Examination, Six Item Screener, Subjective Memory Rating Scale and Deterioration Cognitive Observee

et al. 2013

View full text Add to dashboard Cite

Objective: The aim of this study was to report on the prevalence of cognitive impairment, and to assess the performance and utility of subjective, objective and informant screening tools in a heterogeneous community sample. Method: A sample of 302 elderly participants (>60 years) living in residential homes in a large city in South Africa were screened for the presence of cognitive impairment using objective (Mini-Mental ) screening tools. All tools were compared to the MMSE and the influence of demographic variables on the performance on these tools was considered. Results: Significantly lower MMSE scores were found in participants aged 80-89 years (p=.023) and those who had 8-11 years of education (p=.002). For every one additional year of education, participants were 0.71 times less likely to screen positive on the MMSE. Differential item functioning on various components of the MMSE was demonstrated due to the effects of education, race and gender. There was significant differential performance between the recommended and alternate attention/concentration items (p<.001) with the alternate item favouring better performance. Based on the MMSE cutoff score of < 23, the prevalence of cognitive impairment was 16.9%; the prevalence yielded by the remaining tools ranged from 10.5% using the DECO to 46% as determined by the presence of a SMC. Using the MMSE as the reference standard for the presence of cognitive impairment, the SIS, SMC, SMRS and DECO had sensitivities of 82.3%, 54.6%, 17.0% and 37.5%, and specificities of 71.3%, 57.6%, 87.4% and 96.7% respectively. Age and race influenced performance on the MMSE, SIS and SMRS. Conclusion: Different types of cognitive screening tools yielded varying sensitivities and specificities for identifying cognitive impairment when compared to the MMSE. The influence of race, age and education on test performance highlights the need for suitable, culture-fair screening tools. Locally, the alternate item for attention/concentration should be preferred. However, the serious consequences of population ageing do not appear to be planned for as evidenced by the lack of a national dementia care policy. There is a lack of recent data on morbidity as well as a paucity of research particularly in the areas of cognitive, mental and physical functioning of the elderly. 3 Dementia, a condition largely affecting the aged, requires specialised services, few of which exist either in the public or private health sector in South Africa. The projected increase in the prevalence of Afr J Psychiatry 2013;16:445-455 ORIGINAL

show abstract

Section: Performance Of Toolsmentioning

confidence: 94%

Screening a heterogeneous elderly South African population for cognitive impairment: the utility and performance of the Mini-Mental State Examination, Six Item Screener, Subjective Memory Rating Scale and Deterioration Cognitive Observee

et al. 2013

View full text Add to dashboard Cite

show abstract

“…A meta-analysis of short screening tests in low-prevalence community settings also reported an overall sensitivity of 72% (95% CI 60.4-82.3), and a specificity of 88.2% (95% CI 83.0-92.5) [79] for the MMSE. The performance of the MMSE in the current study sample was less robust.…”

Section: Discussionmentioning

confidence: 99%

“…However, changing the recommended cutoff score of ≤ 23 to ≤ 24 would increase the sensitivity to 80% but decrease the specificity to 67.6%. Despite its limitations, the MMSE may remain the best tool for primary care clinicians who want to rule in or rule out a diagnosis of dementia, provided the length of administration is acceptable [79] . The length of the MMSE and the training and skill required for its administration, scoring and interpretation may make it more suitable for use at a general hospital level as opposed to busy primary health care settings.…”

Section: Discussionmentioning

confidence: 99%

“…The ability of a measure to case-find or 'rule in' dementia with minimal false negatives is its positive predictive value (PPV), and the ability of a measure to screen or 'rule out' a diagnosis with minimal false positives is its negative predictive value (NPV) [9,79] . The PPV and NPV are considered most relevant for clinicians [80] .…”

Section: Measures Of Predictive Validity For Dementia Versus Nondementiamentioning

confidence: 99%

See 1 more Smart Citation

The Sensitivity and Specificity of Subjective Memory Complaints and the Subjective Memory Rating Scale, Deterioration Cognitive Observee, Mini-Mental State Examination, Six-Item Screener and Clock Drawing Test in Dementia Screening

Ramlall¹,

Chipps²,

Bhigjee³

et al. 2013

Dement Geriatr Cogn Disord

View full text Add to dashboard Cite

Background:The effectiveness of dementia screening depends on the availability of suitable screening tools with good sensitivity and specificity to confidently distinguish normal agerelated cognitive decline from dementia. The aim of this study was to evaluate the discriminant validity of 7 screening measures for dementia. Methods: A sample of 140 participants aged ≥60 years living in a residential facility for the aged were assessed clinically and assigned caseness for dementia using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revised diagnostic criteria. Sensitivity and specificity of a selection of the following screening measures were tested using receiver operating characteristic (ROC) analysis for individual and combined tests: the Mini-Mental State Examination (MMSE), Six-Item Screener (SIS), Subjective Memory Complaint, Subjective Memory Complaint Clinical (SMCC), Subjective Memory Rating Scale (SMRS), Deterioration Cognitive Observee (DECO) and the Clock Drawing Test (CDT). Results: Using ROC analyses, the SMCC, MMSE and CDT were found to be 'moderately accurate' in screening for dementia with an area under the curve (AUC) >0.70. The AUCs for the SIS (0.526), SMRS (0.661) and DECO (0.687) classified these measures as being 'less accurate'. At recommended cutoff scores, the SMCC had a sensitivity of 90.9% and specificity of 45.7%; the MMSE had a sensitivity of 63.6% and a specificity of 76.0%, and the CDT had a sensitivity of 44.4% and a specificity of 88.9%. Combining the SMCC and MMSE did not improve their predictive power except for a modest increase when using the sequential rule. Conclusion: The SMCC is composed of valid screening questions that have high sensitivity, are simple to administer and ideal for administration at the community or primary health care level as a first level of 'rule-out' screening. The MMSE can be included at a second stage of screening at the general hospital level and the CDT in specialist clinical settings. Sequential use of the SMCC and MMSE will improve the specificity of the former and the sensitivity of the latter.

show abstract

“…In an overview of systematic reviews of the diagnostic accuracy of brief cognitive assessments for identifying dementia in primary care, we identified two brief cognitive assessments that can be compared to identify the test with better diagnostic performance. These tests were two of the three most frequently assessed brief cognitive assessments within the 13 included systematic reviews [12,13,[19][20][21][22][23][24][25][26][27][28][29] with the MMSE featuring in 8 reviews and the GPCOG featuring in 4 reviews. The clock drawing test (CDT) was the third most frequently assessed tool, featuring in 4 reviews.…”

Section: Introductionmentioning

confidence: 99%

The comparative diagnostic accuracy of the Mini Mental State Examination (MMSE) and the General Practitioner assessment of Cognition (GPCOG) for identifying dementia in primary care: a systematic review protocol

et al. 2017

View full text Add to dashboard Cite

Background: Improved dementia identification is a global health priority, and general practitioners (GPs) are often the first point of contact for people with concerns about their cognition. However, GPs often express uncertainty in using assessment tools and the evidence based on which tests are most accurate in identifying dementia is unclear. In particular, there is little certainty around how the accuracy of available brief cognitive assessments compares within a clinical family practice setting. Grounded in existing brief cognitive assessment evidence, we will compare the diagnostic test accuracy of the Mini Mental State Examination (MMSE) to the General Practitioner Assessment of Cognition (GPCOG) against the best available reference standard when used within a family practice setting. Methods: We will employ robust systematic review methods to assess studies of diagnostic accuracy where both the MMSE and GPCOG have been evaluated as direct comparisons, i.e. within the same study population. This approach will enable us to minimise between-study heterogeneity, to eliminate the risk of bias due to confounding and increase the opportunity to make clinically useful and useable comparisons of diagnostic accuracy across both the MMSE and GPCOG. This systematic review will be conducted using a pragmatic search strategy, refining searches that build upon studies identified as part of our overview of systematic reviews of the diagnostic accuracy of brief cognitive assessments for identifying dementia in primary care. Discussion: Through this systematic review, we aim to improve existing evidence on how the diagnostic accuracy of MMSE and GPCOG compares when used to identify dementia within the family practice setting. We also aim to make clinical practice recommendations based upon the variations in diagnostic accuracy identified between the MMSE and GPCOG.

show abstract

Screening and Case Finding Tools for the Detection of Dementia. Part I: Evidence-Based Meta-Analysis of Multidomain Tests

Cited by 108 publications

References 72 publications

Screening a heterogeneous elderly South African population for cognitive impairment: the utility and performance of the Mini-Mental State Examination, Six Item Screener, Subjective Memory Rating Scale and Deterioration Cognitive Observee

Screening a heterogeneous elderly South African population for cognitive impairment: the utility and performance of the Mini-Mental State Examination, Six Item Screener, Subjective Memory Rating Scale and Deterioration Cognitive Observee

The Sensitivity and Specificity of Subjective Memory Complaints and the Subjective Memory Rating Scale, Deterioration Cognitive Observee, Mini-Mental State Examination, Six-Item Screener and Clock Drawing Test in Dementia Screening

The comparative diagnostic accuracy of the Mini Mental State Examination (MMSE) and the General Practitioner assessment of Cognition (GPCOG) for identifying dementia in primary care: a systematic review protocol

Contact Info

Product

Resources

About