Comparing Diagnostic Accuracy of Cognitive Screening Instruments: A Weighted Comparison Approach

ABSTRACT Cognitive screening instruments are influenced by education and/or culture. In Brazil, as illiteracy and low education rates are high, it is necessary to identify the screening tools with the highest diagnostic accuracy for Alzheimer's disease (AD). Objective: To identify the cognitive screening instruments applied in the Brazilian population with greater accuracy, to detect AD in individuals with a low educational level or who are illiterate. Methods: Systematic search in SciELO, PubMed and LILACS databases of studies that used cognitive screening tests to detect AD in older Brazilian adults with low or no education. Results: We found 328 articles and nine met the inclusion criteria. The identified instruments showed adequate or high diagnostic accuracy. Conclusion: For valid cognitive screening it is important to consider sociocultural and educational factors in the interpretation of results. The construction of specific instruments for the low educated or illiterate elderly should better reflect the difficulties of the Brazilian elderly in different regions of the country.

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Optimising the Cutoffs of Cognitive Screening Instruments in Pragmatic Diagnostic Accuracy Studies: Maximising Accuracy or the Youden Index?

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000369883 ◽

2015 ◽

Vol 39 (3-4) ◽

pp. 167-175 ◽

Cited By ~ 25

Author(s):

Andrew J. Larner

Keyword(s):

Diagnostic Accuracy ◽

Alternative Methods ◽

Youden Index ◽

Test Accuracy ◽

Screening Instruments ◽

Cognitive Screening ◽

Optimal Method ◽

Index Method ◽

State Examination ◽

Addenbrooke’S Cognitive Examination

Background/Aims: The optimal method of establishing test cutoffs or cutpoints for cognitive screening instruments (CSIs) is uncertain. Of the available methods, two base cutoffs on either the maximal test accuracy or the maximal Youden index. The aim of this study was to compare the effects of using these alternative methods of establishing cutoffs. Methods: Datasets from three pragmatic diagnostic accuracy studies which examined the Mini-Mental State Examination (MMSE), the Addenbrooke's Cognitive Examination-Revised (ACE-R), the Montreal Cognitive Assessment (MoCA), and the Test Your Memory (TYM) test were analysed to calculate test sensitivity and specificity using cutoffs based on either maximal test accuracy or the maximal Youden index. Results: For ACE-R, MoCA, and TYM, optimal cutoffs for dementia diagnosis differed from those in index studies when defined using either the maximal accuracy or the maximal Youden index method. Optimal cutoffs were higher for MMSE, MoCA, and TYM when using the maximal Youden index method and consequently more sensitive. Conclusion: Revision of the cutoffs for CSIs established in index studies may be required to optimise performance in pragmatic diagnostic test accuracy studies which more closely resemble clinical practice.

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Diagnostic Accuracy of Cognitive Screening Instruments in Heart Failure

The Journal of Cardiovascular Nursing ◽

10.1097/jcn.0000000000000285 ◽

2016 ◽

Vol 31 (5) ◽

pp. 412-424 ◽

Cited By ~ 5

Author(s):

Jan Cameron ◽

Christina E. Kure ◽

Susan J. Pressler ◽

Chantal F. Ski ◽

Alexander M. Clark ◽

...

Keyword(s):

Heart Failure ◽

Diagnostic Accuracy ◽

Screening Instruments ◽

Cognitive Screening

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Effect Size (Cohen's d) of Cognitive Screening Instruments Examined in Pragmatic Diagnostic Accuracy Studies

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000363735 ◽

2014 ◽

Vol 4 (2) ◽

pp. 236-241 ◽

Cited By ~ 34

Author(s):

Andrew J. Larner

Keyword(s):

Diagnostic Accuracy ◽

Effect Size ◽

Screening Instruments ◽

Cognitive Screening ◽

Cohen’S D ◽

Cohen's D

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Comparing the Diagnostic Accuracy of Two Cognitive Screening Instruments in Different Dementia Subtypes and Clinical Depression

Diagnostics ◽

10.3390/diagnostics9030093 ◽

2019 ◽

Vol 9 (3) ◽

pp. 93 ◽

Cited By ~ 3

Author(s):

Rónán O’Caoimh ◽

D. William Molloy

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Diagnostic Accuracy ◽

Lewy Body ◽

Mini Mental State Examination ◽

Lewy Body Dementia ◽

Screening Instruments ◽

Cognitive Screening ◽

State Examination ◽

Normal Controls

Short but accurate cognitive screening instruments are required in busy clinical practice. Although widely-used, the diagnostic accuracy of the standardised Mini-Mental State Examination (SMMSE) in different dementia subtypes remains poorly characterised. We compared the SMMSE to the Quick Mild Cognitive Impairment (Qmci) screen in patients (n = 3020) pooled from three memory clinic databases in Canada including those with mild cognitive impairment (MCI) and Alzheimer’s, vascular, mixed, frontotemporal, Lewy Body and Parkinson’s dementia, with and without co-morbid depression. Caregivers (n = 875) without cognitive symptoms were included as normal controls. The median age of patients was 77 (Interquartile = ±9) years. Both instruments accurately differentiated cognitive impairment (MCI or dementia) from controls. The SMMSE most accurately differentiated Alzheimer’s (AUC 0.94) and Lewy Body dementia (AUC 0.94) and least accurately identified MCI (AUC 0.73), vascular (AUC 0.74), and Parkinson’s dementia (AUC 0.81). The Qmci had statistically similar or greater accuracy in distinguishing all dementia subtypes but particularly MCI (AUC 0.85). Co-morbid depression affected accuracy in those with MCI. The SMMSE and Qmci have good-excellent accuracy in established dementia. The SMMSE is less suitable in MCI, vascular and Parkinson’s dementia, where alternatives including the Qmci screen may be used. The influence of co-morbid depression on scores merits further investigation.

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Correlation or Limits of Agreement? Applying the Bland-Altman Approach to the Comparison of Cognitive Screening Instruments

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000450701 ◽

2016 ◽

Vol 42 (5-6) ◽

pp. 247-254 ◽

Cited By ~ 10

Author(s):

A.J. Larner

Keyword(s):

Diagnostic Accuracy ◽

Test Scores ◽

Correlation Coefficients ◽

Screening Instruments ◽

Cognitive Screening ◽

Limits Of Agreement ◽

Cognitive Domains ◽

Highly Correlated ◽

State Examination ◽

Addenbrooke’S Cognitive Examination

Background/Aims: Calculation of correlation coefficients is often undertaken as a way of comparing different cognitive screening instruments (CSIs). However, test scores may correlate but not agree, and high correlation may mask lack of agreement between scores. The aim of this study was to use the methodology of Bland and Altman to calculate limits of agreement between the scores of selected CSIs and contrast the findings with Pearson's product moment correlation coefficients between the test scores of the same instruments. Methods: Datasets from three pragmatic diagnostic accuracy studies which examined the Mini-Mental State Examination (MMSE) vs. the Montreal Cognitive Assessment (MoCA), the MMSE vs. the Mini-Addenbrooke's Cognitive Examination (M-ACE), and the M-ACE vs. the MoCA were analysed to calculate correlation coefficients and limits of agreement between test scores. Results: Although test scores were highly correlated (all >0.8), calculated limits of agreement were broad (all >10 points), and in one case, MMSE vs. M-ACE, was >15 points. Conclusion: Correlation is not agreement. Highly correlated test scores may conceal broad limits of agreement, consistent with the different emphases of different tests with respect to the cognitive domains examined. Routine incorporation of limits of agreement into diagnostic accuracy studies which compare different tests merits consideration, to enable clinicians to judge whether or not their agreement is close.

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IPA survey of brief cognitive screening instruments

International Psychogeriatrics ◽

10.1017/s1041610205002693 ◽

2006 ◽

Vol 18 (2) ◽

pp. 281-294 ◽

Cited By ~ 102

Author(s):

Kenneth I. Shulman ◽

Nathan Herrmann ◽

Henry Brodaty ◽

Helen Chiu ◽

Brian Lawlor ◽

...

Keyword(s):

Public Health ◽

Language Education ◽

Word Recall ◽

Screening Instruments ◽

Cognitive Screening ◽

Screening Guidelines ◽

Clock Drawing Test ◽

Test Characteristics ◽

Frequency Of Use ◽

Health Initiatives

Background and objectives: Cognitive screening is a “first step” in detecting dementia and other neuropsychiatric syndromes and hence represents an important public health and clinical initiative. A plethora of cognitive screening instruments has been advocated in recent years, but the extent to which these instruments are used or their effectiveness is not well known. An International Psychogeriatric Association (IPA) survey was designed to determine which cognitive screening instruments were used most frequently by clinicians with special expertise in the neuropsychiatric aspects of old age and also to determine the ones considered most useful by these specialists.Method: Under the auspices of the IPA, the survey was mailed in the fall of 2004 to all IPA members as well as members of the American and Canadian Associations of Geriatric Psychiatry. The survey inquired about demographic information, the frequency of use of cognitive screening instruments, and the value attributed to the cognitive screening instruments. Participants also had an opportunity to provide written commentary.Results: A total of 334 completed surveys were processed. The majority of respondents were geriatric psychiatrists (58%). Of the 20 different instruments that were listed on the survey, only six were selected as “routinely” or “often used” by the survey respondents. These instruments in declining order were: (1) the Folstein Mini-mental State Examination; (2) the Clock Drawing Test; (3) Delayed Word Recall; (4) the Verbal Fluency Test; (5) Similarities; and (6) the Trail Making Test. “Effectiveness” and “ease of administration” were the test characteristics most highly predictive of frequency of use. Open-ended comments highlighted patient factors that continue to provide challenges, including ethnicity/culture, language, education/literacy, and sensory impairment. Respondents concluded that “no single test is adequate.”Conclusions: Psychogeriatricians worldwide routinely use a relatively small number of brief cognitive screening instruments. Further evaluation is necessary as the need increases for cognitive screening guidelines that inform public health initiatives related to dementia and neuropsychiatric syndromes.

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