Buchhave 2008

Study characteristics
Patient sampling	148 MCI patients who performed the cube copying test were recruited from a memory clinic in a prospective manner. Sampling procedure is not fully described (mostly referred by general practitioners). Exclusion criteria involves: patients with other causes of cognitive impairment, including brain tumour, subdural haematoma, CNS infection, major depressive episode, schizophrenia and current alcohol abuse
Patient characteristics and setting	This study included 148 MCI participants who performed the cube copying test and were diagnosed by the Petersen 1999 criteria at baseline. Physicians specialised in cognitive disorders performed a thorough physical, neurological and psychiatric examination, as well as a clinical interview, of each patient at baseline. Furthermore, analysis of apolipoprotein E (APOE) genotype and computed tomography of the brain were done Gender: 32 M, 30 F in MCI‐stable group; 20 M, 43 F in MCI‐AD group; 14 M, 8 F in MCI‐other dementias group Age: 66.2±8.8 years in MCI‐stable; 74.6±6.1 years in MCI‐AD; 72.7±9.0 years in MCI‐other dementia APOE ɛ 4 carrier: 32 in MCI‐stable; 20 in MCI‐AD; 14 in MCI‐other dementia MMSE at baseline: MCI‐stable 27.5±1.8; MCI‐AD 26.8±1.4; MCI‐other dementia 27.0 ± 1.7 Resources of referrals: "The majority of the subjects with MCI (74.1%) were referred by their general practitioners. The remaining MCI subjects were referred by other physicians (19.0%) or the patients themselves (6.8%)." Page 545 Resources of recruitment: memory disorder clinic, Malmo University Hospital, Sweden
Index tests	Mini‐Mental state Examination (MMSE): no details about version, who administered and interpreted the test and scoring systems are provided. No threshold is pre‐specified. After analysis, authors estimated threshold in 28/29 score
Target condition and reference standard(s)	Main target condition for conversion: conversion from MCI to Alzheimer's disease dementia, vascular dementia, dementia by Lewy bodies or frontotemporal dementia Reference standard: for ADD = NINCDS‐ADRDA + DSM‐IIIR criteria; for VaD = DSM‐IIIR criteria + NINDS‐AIREN; for DLB = consensus criteria by McKeith 1999; for frontotemporal dementia = Brun 1994
Flow and timing	Duration of follow‐up: average 5.2 years (range 4 to 6.8 years) At baseline :148 participants with MCI At follow up: 147 participants: 63 MCI‐AD; 22 MCI‐other dementia (15 VD; 4 LBD; 1 SD; 1 FTD; 1 dementia induced by traumatic brain injury); 62 stable‐MCI Conversion to AD N = 85; disease positive = 63; disease negative = 62 (p546); sensitivity = 89%; specificity = 33% (Table 2, p548) TP = 56; FP = 42; FN=7; TN=20 (Calculated in RevMan5) Loss to follow‐up: one participants died before 4 years follow‐up (≅ 1%)
Comparative
Notes
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Unclear
Was a case‐control design avoided?	Yes
Did the study avoid inappropriate exclusions?	Yes
			Low
DOMAIN 2: Index Test All tests
Were sufficient data on MMSE application given for the test to be repeated in an independent study?	No
Were MMSE results interpreted without knowledge of the reference standard?	Unclear
Were MMSE thresholds prespecified?	No
			Low
DOMAIN 3: Reference Standard
Is the assessment used for clinical diagnosis of dementia acceptable?	Yes
Was clinical assessment for dementia performed without knowledge of the MMSE results?	Unclear
			Unclear
DOMAIN 4: Flow and Timing
Was there an appropriate interval between MMSE and the reference standard?	Yes
Did all participants receive the same reference standard?	Yes
Were all participants included in the final analysis?	Yes