Validity and Reliability of the 6-Item Cognitive Impairment Test for Screening Cognitive Impairment: A Review

Background: A large proportion of older adults with dementia remain undiagnosed, presenting to hospital with occult dementia, and are at risk for adverse outcomes, especially delirium. Routine screening for cognitive impairment among older adult patients presenting to acute hospitals could help alleviate this problem; however, this is hampered by time constraints, poor knowledge of screening instruments and lack of consensus as to which screening tool is best. Cognitive tests with attention items may be particularly useful in acute settings, given the importance of delirium detection. However, it is crucial that cognitive screening instruments are fast and reliable. Summary: The Six-Item Cognitive Impairment Test (6-CIT) is a feasible instrument for cognitive screening among older adults attending a general practitioner or hospital. Although researchers have investigated its accuracy in diagnosing cognitive impairment in primary and secondary care settings, its validity in primary care use has been questioned and there are limited validation studies on its use in secondary care. Key Messages: This paper presents a review of validation studies conducted on the 6-CIT. We recommend that larger studies, which test the psychometric properties of the 6-CIT in primary and acute care settings, are conducted to establish recommendations for routine screening use.

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Exploring the Association between Multimorbidity and Cognitive Impairment in Older Adults Living in the Community: A Review of the Literature

Home Health Care Management & Practice ◽

10.1177/10848223211030468 ◽

2021 ◽

pp. 108482232110304

Author(s):

Grace F. Wittenberg ◽

Michelle A. McKay ◽

Melissa O’Connor

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Assessment Tool ◽

Adult Population ◽

Home Health ◽

Adverse Outcomes ◽

Community Dwelling ◽

Cognitive Screening ◽

Review Of The Literature ◽

Increased Risk

Two-thirds of older adults have multimorbidity (MM), or co-occurrence of two or more medical conditions. Mild cognitive impairment (CI) is found in almost 20% of older adults and can lead to further cognitive decline and increased mortality. Older adults with MM are the primary users of home health care services and are at high risk for CI development; however, there is no validated cognitive screening tool used to assess the level of CI in home health users. Given the prevalence of MM and CI in the home health setting, we conducted a review of the literature to understand this association. Due to the absence of literature on CI in home health users, the review focused on the association of MM and CI in community-dwelling older adults. Search terms included home health, older adults, cognitive impairment, and multimorbidity and were applied to the databases PubMed, CINAHL, and PsychInfo leading to eight studies eligible for review. Results show CI is associated with MM in older adults of increasing age, among minorities, and in older adults with lower levels of education. Heart disease was the most prevalent disease associated with increased CI. Sleep disorders, hypertension, arthritis, and hyperlipidemia were also significantly associated with increased CI. The presence of MM and CI was associated with increased risk for death among older adults. Further research and attention are needed regarding the use and development of a validated cognitive assessment tool for home health users to decrease adverse outcomes in the older adult population.

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The Sensitivity and Specificity of Cognitive Screening Instruments to Detect Cognitive Impairment in Older Adults With Severe Psychiatric Illness

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/0891988709358589 ◽

2010 ◽

Vol 23 (2) ◽

pp. 94-99 ◽

Cited By ~ 18

Author(s):

R. Scott Mackin ◽

Liat Ayalon ◽

Leilani Feliciano ◽

Patricia A. Areán

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Sensitivity And Specificity ◽

Psychiatric Illness ◽

Screening Instruments ◽

Cognitive Screening

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Screening instruments for cognitive impairment in older patients in the Emergency Department: a systematic review and meta-analysis

Age and Ageing ◽

10.1093/ageing/afaa183 ◽

2020 ◽

Author(s):

Agneta H Calf ◽

Maaike A Pouw ◽

Barbara C van Munster ◽

Johannes G M Burgerhof ◽

Sophia E de Rooij ◽

...

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Cognitive Impairment ◽

Older Patients ◽

Meta Analysis ◽

Adverse Outcomes ◽

Screening Instruments ◽

Cognitive Screening ◽

Review Protocol ◽

Index Tests

Abstract Background cognitive impairment is highly prevalent among older patients attending the Emergency Department (ED) and is associated with adverse outcomes. Methods we conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of cognitive screening instruments to rule out cognitive impairment in older patients in the ED. A comprehensive literature search was performed in MEDLINE, EMBASE, CINAHL and CENTRAL. A risk of bias assessment using QUADAS-2 was performed. Results 23 articles, examining 18 different index tests were included. Only seven index tests could be included in the meta-analysis. For ruling out cognitive impairment irrespective of aetiology, Ottawa 3 Day Year (O3DY) (pooled sensitivity 0.90; (95% CI) 0.71–0.97) had the highest sensitivity. Fourteen articles focused on screening for cognitive impairment specifically caused by delirium. For ruling out delirium, the 4 A’s Test (4AT) showed highest sensitivity (pooled sensitivity 0.87, 95% confidence interval (95% CI) 0.74–0.94). Conclusions high clinical and methodological heterogeneity was found between included studies. Therefore, it is a challenge to recommend one diagnostic test for use as a screening instrument for cognitive impairment in the ED. The 4AT and O3DY seem most promising for ruling out cognitive impairment in older patients attending the ED. The review protocol was registered in PROSPERO (CRD42018082509).

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Use of potentially inappropriate medications among ambulatory home-dwelling elderly patients with dementia: A review of the literature

Canadian Pharmacists Journal / Revue des Pharmaciens du Canada ◽

10.1177/1715163517701770 ◽

2017 ◽

Vol 150 (3) ◽

pp. 169-183 ◽

Cited By ~ 12

Author(s):

Tejal Patel ◽

Karen Slonim ◽

Linda Lee

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Adverse Events ◽

Inappropriate Medication ◽

Medication Use ◽

Adverse Outcomes ◽

Potentially Inappropriate Medication ◽

Potentially Inappropriate Medications ◽

Inappropriate Medication Use ◽

Inappropriate Medications

Background: Older adults with dementia are at high risk for drug-related adverse outcomes. While much is known about potentially inappropriate medication use in older adults, its prevalence and characteristics among those with dementia are not as well elucidated. We conducted a literature review to examine the prevalence of potentially inappropriate medication use among home-dwelling older adults with dementia. Our secondary aim was to determine the most frequently implicated medications and factors associated with potentially inappropriate medication use. Methods: MEDLINE, EMBASE, CINAHL, and International Pharmaceutical Abstracts were searched between 1946 and 2014 for articles that referenced potentially inappropriate medication use and types of dementia. One reviewer screened all titles and abstracts from the initial search and full-text articles after the initial screen for eligibility, then 2 reviewers independently abstracted data from included studies. Results: Searches yielded 81 articles, of which 7 met inclusion criteria. Prevalence of potentially inappropriate medication use varied from 15% to 46.8%. No single drug or drug class was reported consistently across all studies as the most frequent potentially inappropriate medication, but anticholinergics and benzodiazepines, drugs that affect cognition, were among the most common medications or pharmacological classes listed. Discussion: Older adults with dementia may be particularly vulnerable to potentially inappropriate medications because of cognitive impairment from their condition and the greater likelihood of experiencing adverse events from medications. Given this population’s greater susceptibility to adverse events, more intense medication and patient monitoring may be warranted, especially among those taking anticholinergics and benzodiazepines, as these drugs can contribute to cognitive impairment.

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Comparison of the Mini-Mental State Examination and Computerized Brief Cognitive Screening Test as Cognitive Screening Tools in Patients with Mild Cognitive Impairment

Current Alzheimer Research ◽

10.2174/1567205018666211215151418 ◽

2021 ◽

Vol 18 ◽

Author(s):

Che-Sheng Chu ◽

I-Chen Lee ◽

Chuan-Cheng Hung ◽

I-Ching Lee ◽

Chi-Fa Hung ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Normal Control ◽

Internal Consistency ◽

Mental State ◽

Screening Test ◽

Mini Mental State Examination ◽

Cognitive Screening ◽

Validity And Reliability ◽

State Examination

Background: The aim of this study was to establish the validity and reliability of the Computerized Brief Cognitive Screening Test (CBCog) for early detection of cognitive impairment. Method: One hundred and sixty participants, including community-dwelling and out-patient volunteers (both men and women) aged ≥ 65 years, were enrolled in the study. All participants were screened using the CBCog and Mini-Mental State Examination (MMSE). The internal consistency of the CBCog was analyzed using Cronbach’s α test. Areas under the curves (AUCs) of receiver operating characteristic analyses were used to test the predictive accuracy of the CBCog in detecting mild cognitive impairment (MCI) in order to set an appropriate cutoff point. Results: The CBCog scores were positively correlated with the MMSE scores of patients with MCI-related dementia (r = 0.678, P < .001). The internal consistency of the CBCog (Cronbach’s α) was 0.706. It was found that the CBCog with a cutoff point of 19/20 had a sensitivity of 97.5% and a specificity of 53.7% for the diagnosis of MCI with education level ≥ 6 years. The AUC of the CBCog for discriminating the normal control elderly from patients with MCI (AUC = 0.827, P < 0.001) was larger than that of the MMSE for discriminating the normal control elderly from patients with MCI (AUC= 0.819, P < .001). Conclusion: The CBCog demonstrated to have sufficient validity and reliability to evaluate mild cognitive impairment, especially in highly educated elderly people.

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Detection of Mild Cognitive Impairment in an At-Risk Group of Older Adults: Can a Novel Self-Administered Serious Game-Based Screening Test Improve Diagnostic Accuracy?

Journal of Alzheimer s Disease ◽

10.3233/jad-200880 ◽

2020 ◽

Vol 78 (1) ◽

pp. 405-412

Author(s):

Stelios Zygouris ◽

Paraskevi Iliadou ◽

Eftychia Lazarou ◽

Dimitrios Giakoumis ◽

Konstantinos Votis ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Neuropsychological Test ◽

Cognitive Disorders ◽

Assessment Method ◽

Serious Game ◽

Screening Instruments ◽

Classification Rate ◽

Healthy Older Adults

Background: Literature supports the use of serious games and virtual environments to assess cognitive functions and detect cognitive decline. This promising assessment method, however, has not yet been translated into self-administered screening instruments for pre-clinical dementia. Objective: The aim of this study is to assess the performance of a novel self-administered serious game-based test, namely the Virtual Supermarket Test (VST), in detecting mild cognitive impairment (MCI) in a sample of older adults with subjective memory complaints (SMC), in comparison with two well-established screening instruments, the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE). Methods: Two groups, one of healthy older adults with SMC (N = 48) and one of MCI patients (N = 47) were recruited from day centers for cognitive disorders and administered the VST, the MoCA, the MMSE, and an extended pencil and paper neuropsychological test battery. Results: The VST displayed a correct classification rate (CCR) of 81.91% when differentiating between MCI patients and older adults with SMC, while the MoCA displayed of CCR of 72.04% and the MMSE displayed a CCR of 64.89%. Conclusion: The three instruments assessed in this study displayed significantly different performances in differentiating between healthy older adults with SMC and MCI patients. The VST displayed a good CCR, while the MoCA displayed an average CCR and the MMSE displayed a poor CCR. The VST appears to be a robust tool for detecting MCI in a population of older adults with SMC.

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Cognitive screening tools for identification of dementia in illiterate and low-educated older adults, a systematic review and meta-analysis

International Psychogeriatrics ◽

10.1017/s1041610216001976 ◽

2017 ◽

Vol 29 (6) ◽

pp. 897-929 ◽

Cited By ~ 17

Author(s):

Stella-Maria Paddick ◽

William K. Gray ◽

Jackie McGuire ◽

Jenny Richardson ◽

Catherine Dotchin ◽

...

Keyword(s):

Older Adults ◽

Validation Studies ◽

Meta Analysis ◽

Significant Proportion ◽

Educational Background ◽

Screening Tools ◽

Screening Tests ◽

Cognitive Screening ◽

Low Literacy ◽

Prevalence Studies

ABSTRACTBackground:The majority of older adults with dementia live in low- and middle-income countries (LMICs). Illiteracy and low educational background are common in older LMIC populations, particularly in rural areas, and cognitive screening tools developed for this setting must reflect this. This study aimed to review published validation studies of cognitive screening tools for dementia in low-literacy settings in order to determine the most appropriate tools for use.Method:A systematic search of major databases was conducted according to PRISMA guidelines. Validation studies of brief cognitive screening tests including illiterate participants or those with elementary education were eligible. Studies were quality assessed using the QUADAS-2 tool. Good or fair quality studies were included in a bivariate random-effects meta-analysis and a hierarchical summary receiver operating characteristic (HSROC) curve constructed.Results:Forty-five eligible studies were quality assessed. A significant proportion utilized a case–control design, resulting in spectrum bias. The area under the ROC (AUROC) curve was 0.937 for community/low prevalence studies, 0.881 for clinic based/higher prevalence studies, and 0.869 for illiterate populations. For the Mini-Mental State Examination (MMSE) (and adaptations), the AUROC curve was 0.853.Conclusion:Numerous tools for assessment of cognitive impairment in low-literacy settings have been developed, and tools developed for use in high-income countries have also been validated in low-literacy settings. Most tools have been inadequately validated, with only MMSE, cognitive abilities screening instrument (CASI), Eurotest, and Fototest having more than one published good or fair quality study in an illiterate or low-literate setting. At present no screening test can be recommended.

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Evaluating Residual Cognition in Advanced Cognitive Impairment: The Residual Cognition Assessment

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000520322 ◽

2021 ◽

pp. 1-13

Author(s):

Alex Soli ◽

Giacomina Savoldelli ◽

Angelica Rota ◽

Sara Zonca ◽

Gloria Belotti ◽

...

Keyword(s):

Cognitive Impairment ◽

Intraclass Correlation ◽

Cognitive Status ◽

Short Version ◽

Cognitive Screening ◽

Advanced Dementia ◽

Validity And Reliability ◽

Clinical Dementia Rating ◽

Internal Reliability ◽

Floor Effect

Background: In nursing homes, most of the patients with dementia are affected by severe cognitive disorder. Care interventions follow an accurate and recurring multidimensional assessment, including cognitive status. There is still a need to develop new performance-based scales for moderate-to-advanced dementia. Objectives: The development of the Residual Cognition Assessment (RCA) responds to the need to create new scales for global cognitive screening in advanced dementia, with some peculiar features: performance based, brief (<5 m), available without specific training, and suitable for nonverbal patients with minimal distress. Methods: Two raters have administered the RCA and the Severe Impairment Battery-short version (SIB-S) to 84 participants with MMSE = 0. After 2–3 weeks, the same sample has been retested. The RCA has been also administered to 40 participants with MMSE 1–10 for a comparison. Results: The RCA has exhibited excellent values for test-retest reliability (intraclass correlation [ICC] = 0.956) as well as for inter-rater reliability (ICC = 0.997). The concurrent validity analyzes have shown strong correlations between the RCA and the SIB-S with ρ = 0.807 (p < 0.01), and the RCA and the Clinical Dementia Rating (CDR) with ρ = −0.663 (p < 0.01). Moderate correlation has been found between the RCA and the Functional Assessment Staging Scale with ρ = −0.435 (p < 0.01). The instrument has showed high internal reliability, too (total: α = 0.899). The RCA has low floor effect (2%) with respect to the SIB-S (58%) but shows ceiling effect in the MMSE 1–10 sample (50%). The ROC curve analyses demonstrate that the RCA is acceptably able to discriminate between subjects with CDR 4/5 with an AUC of 0.92. Exploratory factor analysis shows 3 factors, defined as three major degrees of cognitive performance in advanced dementia, indeed hierarchically structured in three possible levels of decline. Conclusions: The RCA has showed excellent validity and reliability as well as good sensitivity to identify advanced cognitive impairment in dementia, without floor effect. The RCA seems complementary to the MMSE, so advisable when the latter reaches 0. Administration and scoring are simple, and only few minutes are required to assess the patient. The RCA can discriminate at least 3 different major stages in advanced dementias: severe, profound, and late.

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Cognitive screening instruments for dementia: comparing metrics of test limitation

Dementia & Neuropsychologia ◽

10.1590/1980-57642021dn15-040005 ◽

2021 ◽

Vol 15 (4) ◽

pp. 458-463

Author(s):

Andrew J. Larner

Keyword(s):

Cognitive Impairment ◽

High Sensitivity ◽

Misclassification Rate ◽

Test Accuracy ◽

Screening Instruments ◽

Cognitive Screening ◽

Net Benefit ◽

Likelihood Ratios ◽

Sensitivity Specificity ◽

State Examination

ABSTRACT Cognitive screening instruments (CSIs) for dementia and mild cognitive impairment are usually characterized in terms of measures of discrimination such as sensitivity, specificity, and likelihood ratios, but these CSIs also have limitations. Objective: The aim of this study was to calculate various measures of test limitation for commonly used CSIs, namely, misclassification rate (MR), net harm/net benefit ratio (H/B), and the likelihood to be diagnosed or misdiagnosed (LDM). Methods: Data from several previously reported pragmatic test accuracy studies of CSIs (Mini-Mental State Examination, the Montreal Cognitive Assessment, Mini-Addenbrooke’s Cognitive Examination, Six-item Cognitive Impairment Test, informant Ascertain Dementia 8, Test Your Memory test, and Free-Cog) undertaken in a single clinic were reanalyzed to calculate and compare MR, H/B, and the LDM for each test. Results: Some CSIs with very high sensitivity but low specificity for dementia fared poorly on measures of limitation, with high MRs, low H/B, and low LDM; some had likelihoods favoring misdiagnosis over diagnosis. Tests with a better balance of sensitivity and specificity fared better on measures of limitation. Conclusions: When deciding which CSI to administer, measures of test limitation as well as measures of test discrimination should be considered. Identification of CSIs with high MR, low H/B, and low LDM, may have implications for their use in clinical practice.

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