Screening for Preclinical Disease: Test and Disease Characteristics

Herman, Cheryl R.; Gill, Harmindar K.; Eng, John; Fajardo, Laurie L.

doi:10.2214/ajr.179.4.1790825

Cited by 97 publications

(68 citation statements)

References 35 publications

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“…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%

“…Combining measures in parallel or sequentially can address the challenges of the 'tradeoff' between sensitivity and specificity [9,80,84] . The SMCC (a single-domain measure) and the MMSE (a multidomain measure) were combined in 4 different ways and tested for improvements in accuracy of screening for dementia compared to the use of the MMSE or SMCC alone ( table 4 ).…”

Section: Combining Screening Measuresmentioning

confidence: 99%

“…The ability of a measure to 'rule out' or 'rule in' the likely presence of a condition with minimal false positives and minimal false negatives is captured by quantification of its sensitivity, specificity and positive or negative predictive values [9,10] . In view of the considerable burden posed by dementia [11] and MCI [12] , and the absence of pathognomonic biological markers for dementia [13] , there is a need to identify suitable, effective screening measures that have been validated locally.…”

Section: Introductionmentioning

confidence: 99%

“…The challenges associated with cross-cultural cognitive assessments are well documented [13][14][15] . Effective screening requires measures that are widely accessible, simple to administer, inexpensive, culturally appropriate, valid and reliable, that cause minimum discomfort and are sensitive to preclinical detection of disease states [9] . This is particularly important in low-income countries, where the language and culture may be very different from those where the measures have been developed.…”

Section: Introductionmentioning

confidence: 99%

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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

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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.

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Section: Measures Of Predictive Validity For Dementia Versus Nondementiamentioning

confidence: 99%

Section: Combining Screening Measuresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

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“…The 2 major objectives of a good screening program are: (1) detection of disease at a stage when treatment can be more effective than it would be after the patient develops signs and symptoms, and (2) identification of risk factors that increase the likelihood of developing the disease and use of this knowledge to prevent or lessen the disease by modifying the risk factors [2]. To fulfill these objectives, a screening test and the disease it screens for must meet the following criteria.…”

mentioning

confidence: 99%

What Makes a Screening Exam "good"?

Herman

2006

AMA Journal of Ethics

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Periodic Screening Pelvic Examination

Guirguis-Blake

Henderson

Perdue

2017

JAMA

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IMPORTANCE Recent changes in the periodicity of cervical cancer screening have led to questions about the role of screening pelvic examinations among asymptomatic women.OBJECTIVE To systematically review literature on health benefits, accuracy, and harms of the screening pelvic examination for gynecologic conditions for the US Preventive Services Task Force (USPSTF).DATA SOURCES MEDLINE, PubMed, and Cochrane Central Register of Controlled Trials for relevant English-language studies published through January 13, 2016, with surveillance through August 3, 2016.STUDY SELECTION Two reviewers independently screened abstracts and studies. The search yielded 8678 unique citations; 316 full-text articles were reviewed, and 9 studies including 27 630 patients met inclusion criteria. DATA EXTRACTION AND SYNTHESISTwo reviewers rated study quality using USPSTF criteria.MAIN OUTCOMES AND MEASURES Morbidity; mortality; diagnostic accuracy for any gynecologic cancer or condition except cervical cancer, gonorrhea, and chlamydia, which are covered by other USPSTF screening recommendations; harms (false-positive rates, false-negative rates, surgery rates). RESULTSNo trials examined the effectiveness of the pelvic examination in reducing all-cause mortality, reducing cancer-and disease-specific morbidity and mortality, or improving quality of life. Eight studies reported accuracy for the screening pelvic examination: ovarian cancer (4 studies; n = 26 432), bacterial vaginosis (2 studies; n = 930), trichomoniasis (1 study; n = 779), and genital herpes (1 study; n = 779). In the 4 ovarian cancer screening studies, low prevalence of ovarian cancer consistently resulted in low positive predictive values (PPVs) and false-positive rates, with a lack of precision in accuracy estimates (sensitivity range, 0%-100%; specificity range, 91%-99%; PPV range, 0%-3.6%; negative predictive value [NPV] range, Ն99%). Each diagnostic accuracy study for bacterial vaginosis, trichomoniasis, and genital herpes was performed in a high-prevalence population with substantial proportions of symptomatic patients and reported accuracy characteristics for individual physical examination findings (bacterial vaginosis, homogeneous discharge:

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Screening for Preclinical Disease: Test and Disease Characteristics

Cited by 97 publications

References 35 publications

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 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

What Makes a Screening Exam "good"?

Periodic Screening Pelvic Examination

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