Devanand 2008

Study characteristics
Patient sampling	A total of 148 outpatients with memory complaints (MCI broadly defined) from a Memory Disorders Clinic were consecutive recruited Exclusion criteria: not reported
Patient characteristics and setting	A total of 148 patients were included in analysis. Sample size estimation = 150 patients; two patients were excluded by misdiagnosis. Baseline MCI was determined post hoc due to the study began before MCI criteria were published Demographic data presented for 39 MCi‐converters and 109 MCI non‐converters was provided on Table 1 (Page 14): Gender: Converters: 56.4% F; Non‐converters: 55.1% F Age: Converters: 73.2± 7.1 years; Non‐converters: 64.9 ± 9.9 years Education (years): Converters: 14 ± 4.7 years; Non‐converters: 15.4 ± 4.1 years APOE ɛ4 carrier: Converters: 34.3%; Non‐converters: 23.6% MMSE at baseline: Converters: 26.3± 2.2; Non‐converters: 27.9 ± 2.0 Sources of referral: the majority (52%) were physician referred, 25% were self‐referred, and 23% were referred by family or friends or other sources (Devanand 2007) Sources of recruitment: Memory Disorders Clinic (jointly run by NY Psychiatric Institute, Columbia University)
Index tests	Mini‐Mental state Examination (MMSE): no details about version and scoring systems are provided. It is unclear who administered the baseline test. Two expert raters reviewed the neuropsychological information to determine inclusion No threshold was used. Quote: "Based on the fitted logistic regression and dichotomizing estimated risk at 0.5, likelihood ratios with 95% CI were calculated"
Target condition and reference standard(s)	Target condition: Conversion from MCI to Alzheimer`s disease dementia Reference standard: DSM‐ IV criteria + NINCDS‐ADRDA criteria. The endpoint of conversion to AD required diagnosis at two consecutive annual outcome criteria Two expert raters (DPD and YS) made a consensus diagnosis at each follow‐up, while remaining blind to data from previous visits (page 3)
Flow and timing	At baseline = 148 patients were included During 1 to 9 years of follow‐up: 39 converters, 109 non‐converters, 63 healthy controls For analysis of sensitivity and specificity, authors selected a sub‐sample of 125 patients with 3‐years of follow‐up: At 3‐years of follow‐up: 33 converters, 92 non‐converters TP = 9; FN = 9; FP = 24; TN = 83 Sensitivity = 26.8%; Specificity = 90% (calculated in RevMan5) Loss to follow up: 22 patients dropped out before the 3‐year follow up time‐point
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?	Yes
Was a case‐control design avoided?	Yes
Did the study avoid inappropriate exclusions?	Unclear
			Low
DOMAIN 2: Index Test All tests
Were sufficient data on MMSE application given for the test to be repeated in an independent study?	Unclear
Were MMSE results interpreted without knowledge of the reference standard?	Yes
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?	Yes
			Low
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?	No