Test Accuracy of Cognitive Screening Tests for Diagnosis of Dementia and Multidomain Cognitive Impairment in Stroke

The diagnostic accuracy of the short Montreal Cognitive Assessment (s-MoCA), a cognitive screening instrument recently derived by item response theory and computerized adaptive testing from the original MoCA, for the diagnosis of dementia and mild cognitive impairment (MCI) was assessed in 2 patient cohorts referred to a dedicated memory clinic in order to examine the validity and reproducibility of s-MoCA. Diagnosis used standard clinical diagnostic criteria for dementia and MCI as reference standard (prevalence of cognitive impairment = 0.43 and 0.46 in each cohort, respectively). There were significant differences in s-MoCA test scores for dementia, MCI, and subjective memory impairment ( P ≤ .01), and s-MoCA effect sizes (Cohen d) were medium to large (range: 0.65-1.42) for the diagnosis of dementia and MCI. Using the cut-off for s-MoCA specified in the index study, it proved highly sensitive (>0.9) for diagnosis of dementia but with poor specificity (≤0.25), with moderate sensitivity (≥0.75) and specificity (≥0.60) for diagnosis of MCI. In conclusion, in these pragmatic diagnostic test accuracy studies, s-MoCA proved acceptable and sensitive for the diagnosis of cognitive impairment in a memory clinic setting, with a performance similar to that of the original MoCA.

Download Full-text

Is the Clock Drawing Test a screening tool for the diagnosis of mild cognitive impairment? A systematic review

International Psychogeriatrics ◽

10.1017/s1041610209990676 ◽

2009 ◽

Vol 22 (1) ◽

pp. 56-63 ◽

Cited By ~ 44

Author(s):

Lena Ehreke ◽

Melanie Luppa ◽

Hans-Helmut König ◽

Steffi G. Riedel-Heller

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Literature Search ◽

Screening Tool ◽

Cognitive Screening ◽

Clock Drawing Test ◽

Clock Drawing ◽

Drawing Test ◽

Diagnosis Of Dementia ◽

Mean Differences

ABSTRACTBackground:The clock drawing test (CDT) is a common and widely used cognitive screening instrument for the diagnosis of dementia. However, it has remained unclear whether it is a suitable method to identify mild cognitive impairment (MCI). The aim of this paper is to review systematically the studies concerning the utility of the CDT in diagnosing MCI.Method:A systematic literature search was conducted. All studies dealing with utility of CDT in diagnosing MCI regardless of the applied CDT scoring system and MCI concept were selected.Results:Nine relevant studies were identified. The majority of the studies compared average CDT scores of cognitively healthy and mildly impaired subjects, and four of them identified significant mean differences. If reported, sensitivity and specificity have been mostly unsatisfactory.Conclusion:CDT should not be used for MCI-screening.

Download Full-text

Test Accuracy of Short Screening Tests for Diagnosis of Delirium or Cognitive Impairment in an Acute Stroke Unit Setting

Stroke ◽

10.1161/strokeaha.113.001724 ◽

2013 ◽

Vol 44 (11) ◽

pp. 3078-3083 ◽

Cited By ~ 58

Author(s):

Rosalind Lees ◽

Sinead Corbet ◽

Christina Johnston ◽

Emma Moffitt ◽

Grahame Shaw ◽

...

Keyword(s):

Cognitive Impairment ◽

Acute Stroke ◽

Stroke Unit ◽

Screening Tests ◽

Test Accuracy ◽

Acute Stroke Unit

Download Full-text

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.

Download Full-text

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

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000484438 ◽

2018 ◽

Vol 45 (5-6) ◽

pp. 300-307 ◽

Cited By ~ 13

Author(s):

John C. Williamson ◽

Andrew J. Larner

Keyword(s):

Diagnostic Test ◽

Cognitive Disorders ◽

High Sensitivity ◽

Diagnostic Test Accuracy ◽

Test Accuracy ◽

Cognitive Screening ◽

Predictive Values ◽

Diagnosis Of Dementia ◽

Accuracy Study ◽

Secondary Care Setting

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.

Download Full-text

A new Brief computerized cognitive screening battery (CompCogs) for early diagnosis of Alzheimer's disease

Dementia & Neuropsychologia ◽

10.1590/s1980-57642009dn20100004 ◽

2008 ◽

Vol 2 (1) ◽

pp. 13-19 ◽

Cited By ~ 2

Author(s):

Helenice Charchat Fichman ◽

Ricardo Nitrini ◽

Paulo Caramelli ◽

Koichi Sameshima

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Logistic Regression ◽

Early Diagnosis ◽

Short Term Memory ◽

Neuropsychological Test ◽

Screening Tests ◽

Cognitive Screening ◽

Cognitive Components ◽

Diagnosis Of Dementia

Abstract Screening tests for early diagnosis of dementia are of great clinical relevance. The ideal test set must be brief and reliable, and should probe cognitive components impaired in Alzheimer's disease (AD). Objectives: To develop a new Computerized Cognitive Screening test (CompCogs), and to investigate its validity for the early diagnosis of AD, and evaluate its heuristic value in understanding the processing of information in AD. Methods: The computerized neuropsychological performance battery, originally including six tests, was applied in forty seven patients with probable mild AD and 97 controls matched for age and education. This computerized neuropsychological test battery, developed with MEL Professional, allows control of timing and order of stimuli presentation, as well as recording of response type and latency. A brief-screening version, CompCogs, was selected using the most discriminative neuropsychological test variables derived from logistic regression analysis. Full battery administration lasted about 40 minutes, while the CompCogs took only 15 minutes. Results: CompCogs included the Face test (correct response) and Word and Forms with Short term memory tests (reaction time). CompCogs presented 91.8% sensitivity and 93.6% specificity for the diagnosis of AD using ROC analyses of AD diagnosis probability derived by logistic regression. Conclusions: CompCogs showed high validity for AD early diagnosis and, therefore, may be a useful alternative screening instrument.

Download Full-text

Accuracy of Telephone-Based Cognitive Screening Tests: Systematic Review and Meta-Analysis

Current Alzheimer Research ◽

10.2174/1567205017999200626201121 ◽

2020 ◽

Vol 17 (5) ◽

pp. 460-471

Author(s):

Emma Elliott ◽

Claire Green ◽

David J. Llewellyn ◽

Terence J. Quinn

Keyword(s):

Meta Analysis ◽

Cognitive Status ◽

Screening Tests ◽

Test Accuracy ◽

Supporting Evidence ◽

Cognitive Screening ◽

Cognitive Assessments ◽

Face To Face ◽

The Face ◽

The Many

Background: Telephone-based cognitive assessments may be preferable to in-person testing in terms of test burden, economic and opportunity cost. Objective: We sought to determine the accuracy of telephone-based screening for the identification of dementia or Mild Cognitive Impairment (MCI). Methods: Five multidisciplinary databases were searched. Two researchers independently screened articles and extracted data. Eligible studies compared any multi-domain telephone-based assessment of cognition to the face-to-face diagnostic evaluation. Where data allowed, we pooled test accuracy metrics using the bivariate approach. Results: From 11,732 titles, 34 papers were included, describing 15 different tests. There was variation in test scoring and quality of included studies. Pooled analyses of accuracy for dementia: Telephone Interview for Cognitive Status (TICS) (<31/41) sensitivity: 0.92, specificity: 0.66 (6 studies); TICSmodified (<28/50) sensitivity: 0.91, specificity: 0.91 (3 studies). For MCI: TICS-modified (<33/50) sensitivity: 0.82, specificity: 0.87 (3 studies); Telephone-Montreal Cognitive Assessment (<18/22) sensitivity: 0.98, specificity: 0.69 (2 studies). Conclusion: There is limited diagnostic accuracy evidence for the many telephonic cognitive screens that exist. The TICS and TICS-m have the greatest supporting evidence; their test accuracy profiles make them suitable as initial cognitive screens where face to face assessment is not possible.

Download Full-text

Abstract 19350: The Decline of the Montreal Cognitive Test Can Detect Post-stroke Cognitive Decline Determined by a Formal Neuropsychological Evaluation

Circulation ◽

10.1161/circ.132.suppl_3.19350 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Kenny Xu ◽

Catherine Dong ◽

Christopher Chen

Keyword(s):

Cognitive Impairment ◽

Cognitive Decline ◽

Screening Tests ◽

Cognitive Test ◽

Cognitive Screening ◽

Post Stroke ◽

Diagnostic Status ◽

Cerebrovascular Events ◽

Moderate Cognitive Impairment ◽

Ischemic Attack

Objective: We aimed to establish the association of decline in cognitive screening tests scores, the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE), with the decline in neuropsychological diagnostic status from 3-6 months to a year later. Method: Patients with ischemic stroke/ Transient Ischemic Attack (TIA) received the MoCA and MMSE within 14 days after stroke, then 3-6 months and 1 year later. The decline in MoCA and MMSE scores were defined by reduction of 2 points or more in total scores, while stable/improved MoCA scores referred to reduction of MoCA scores less than 2 or improved scores. The decline in neuropsychological diagnostic status was defined by category transition from no cognitive impairment to any cognitive impairment (≥1 domain), from mild cognitive impairment (impairment in 1-2 domains) to moderate cognitive impairment (impairment >2 domains) and dementia (i.e., functional loss associated with cognitive impairment, DSM-IV criteria), as well as from moderate cognitive impairment to dementia. Results: At baseline, most patients were Chinese (70.3%) and males (69.8%) with age of 59.8 ± 11.6 years and education of 7.7 ± 4.3 years. 327 out of 400 stroke/TIA patients completed neuropsychological assessments at 3-6 months and 275 completed at 1 year after their index cerebrovascular events. Of these, 31 (11.3%) had decline in neuropsychological diagnostic status. Logistic regression was used to model the association between probability of decline in neuropsychological diagnostic status and the decline in MMSE or MoCA scores. There were not significant associations between the decline of neuropsychological diagnostic status and the decline in MMSE scores. Controlling baseline MoCA scores and the change scores of MoCA from baseline to 3-6 months, patients with decline in MoCA scores (reduction of 2 points or more) were associated with higher risks of decline in neuropsychological diagnostic status, relative to those with stable/ improved MoCA scores (odd ratio=3.21, p=0.004). Conclusion: The decline in MoCA scores are associated with a higher risks for decline in neuropsychological diagnostic status from 3-6 months to 1 year, therefore may be used to detect post-stroke cognitive decline.

Download Full-text

Diagnosis of Dementia and Cognitive Impairment

Diagnostics ◽

10.3390/diagnostics9040180 ◽

2019 ◽

Vol 9 (4) ◽

pp. 180

Author(s):

Larner

Keyword(s):

Cerebrospinal Fluid ◽

Differential Diagnosis ◽

Cognitive Impairment ◽

Cognitive Disorders ◽

Clinical Encounter ◽

Cognitive Screening ◽

Special Issue ◽

Neurological Signs ◽

Cerebrospinal Fluid Biomarkers ◽

Diagnosis Of Dementia

In this special issue of Diagnostics, expert contributors have produced up-to-date research studies and reviews on various topics related to the diagnosis of dementia and cognitive impairment. The methods of the assessments discussed extend from simple neurological signs, which may be elicited in the clinical encounter, through cognitive screening instruments, to sophisticated analyses of neuroimaging and cerebrospinal fluid biomarkers of disease. It is hoped that these various methods may facilitate earlier diagnosis of dementia and its subtypes, and provide differential diagnosis of depression and functional cognitive disorders, as a prelude to meaningful interventions.

Download Full-text