Table 1.

PICO 1 and PICO 2 ED Cognitive Impairment Assessment Instruments Evaluated for Diagnostic Accuracy and Time to Complete

Gold Standard	Gold Standard Cutoff Score	Comparison	Sensitivity, %	Specificity, %	PPV, %	NPV, %	PLR	NLR	AUC	Time to Complete, min	Other Measures	Reference
MMSE	<24	Six-Item Screener	94	86	68	98				<1		Wilber11*
	<24	Six-Item Screener	63	81	60	83			0.77			Wilber12*
	<24	Six-Item Screener	74	77			3.3	0.33	0.83			Carpenter3*
	<24	Mini-Cog	75	85	57	93				1.5		Wilber11,*
		Quick Confusion Scale								2.35	Correlation: r = 0.783	Huff13,*
	<24	Quick Confusion Scale	64	85							Correlation: r = 0.61	Stair14,*
	<24	AMT10	Score 8: 92	75	74	92						Schofield15
	<24	AMT4	Score 3: 80	88	84	85
	<25	Ottawa 3DY–English	Nurses 90.1	60								Eagles16,*
			Physicians 72.7	50
	<24	Ottawa 3DY–English	71.4	56.3								Barbic17
	<25	Ottawa 3DY–English	93.8	72.8			3.5	0.08				Wilding18,*
	<25	Ottawa 3DY–English	Nurses 84.6	54								Eagles19,*
			Physicians 78.9	70
	<24	Ottawa 3DY–English	95	51			2	0.1				Carpenter20,21,*
	<25	Short Blessed Test	85.7	58.3								Barbic17
	<24	Short Blessed Test	95	68			2.7	0.08	0.89			Carpenter20,21,*
	<25	Animal Fluency Test	90.6	39.3			1.5	0.24				Wilding18,*
	<24	Patient AD8	37	82			2	0.77	0.67			Carpenter3,*
	<24	Caregiver AD8	66	67			2.2	0.27	0.825			Carpenter20,21,*
	<24	Caregiver AD8	63	79			3	0.44	0.74			Carpenter3,*
	<24	Brief Alzheimer’s Screen	100	53					0.945			Carpenter20
	<24	Physical Assessment									Handgrip strength, 0.67; TNF, −0.34; IL-6, −0.36; visfatin, −0.01	Huang22
	<24	Documentation in notes									Percentage of undocumented cognitive impairment in patients with abnormal MMSE score in past medical history, ED physician note, inpatient physician note, and emergency nurse note: PMH: 86%, emergency physician: 72%, emergency nurse: 84%, inpatient physician: 60%	Heidt23
	<24	Physician’s Assessment									% agreement: 67%	Dziedzic24,*
	N/A	Serious Game									Correlation of game response time, −0.558; and accuracy, −0.104 (nonsignificant) with MMSE score	Tong25
MoCA	<26	Caregiver AD8	54	78			2.4	0.59				Turner26
	<26	Short Blessed Test	47	89			4.1	0.6				Turner26
	<26	Brief Alzheimer’s Screen	61	83			3.6	0.47				Turner26
	N/A	Serious Game									Correlation of game response time, −0.339; and accuracy, −0.042 (nonsignificant) with MoCA score	Tong25
CAM		Ottawa 3DY–French	Delirium detection 85	57.7								Bedard27
		4 A’s Test (4-AT)	84	74	19	98						Gagne28
TICS-m	<27	4 A’s Test (4-AT)	49	87	48	88						Gagne28
	<27	Ottawa 3DY–French	Delirium detection 84.2	60			2.0	0.3				Bedard29
	<27	Ottawa 3DY–French	Cognitive impairment 76.7	70								Bedard27
	<27	Ottawa 3DY–French	Cognitive impairment 76.2	70			2.4	0.4				Bedard29
	<27	Bergman-Paris Question	86.5	30	30	90						Lague30,*
Combined CAM-ICU, AD8, sMMSE	Positive screen on any tests	AMT4	53.0	96	94.6	73.3	14.7	0.5	0.75			Dyer31
Expert diagnosis†	N/A	4AT‡	84	63	39	94			0.83			O’Sullivan32
		6-CIT‡	81	76	46	94
		APOP								1.5		Blomaard33
		Caregiver AD8								<6		Dyer55
		OMC								~2		Gerson34
		MoCA								~10		Han35
		Ottawa 3DY–English								<2
		Short Blessed Test								<5
		6-CIT								2–3		Lucke36
		4AT								2.6		Myrstad37
		Emergency Geriatric Screen								<5		Schoenengerger38
		Short-term memory recall test								2–5		Yamamoto39

4AT, 4 A’s Test; AD8, Ascertain Dementia 8; AMT, Abbreviated Mental Test; APOP, acutely presenting older patient; AUC, area under the curve; CAM, Confusion Assessment Method; CAM-ICU, Confusion Assessment MethodeIntensive Care Unit; IL-6, interleukin 6; MoCA, Montreal Cognitive Assessment; MMSE, Mini-Mental State Examination; N/A, not applicable; NLR, negative likelihood ratio; NPV, negative predictive value; PLR, positive likelihood ratio; OMC, Orientation-Memory-Concentration; PMH, past medical history; PPV, positive predictive value; 6-CIT, Six-Item Cognitive Impairment Test; TICS-m, Telephone Interview for Cognitive Statusemodified; TNF, tumor necrosis factor.

^*Article included for PICO 1 and PICO 2.

^†Expert (geriatrician with special interest in delirium/dementia) delirium and dementia diagnosis using Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria, using researcher-collected Standardized Mini Mental State Examination (sMMSE), Delirium Rating ScaleeRevised 98 (DRS-R98), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) data, and demographic data, presenting complaint, and information from the general physician referral letter or hospital notes about dementia diagnosis.

^‡Multiple cutoffs were reported and diagnostic accuracy was measured. Only 1 cutoff is presented.