Meguro 2007b

Study characteristics
Patient sampling	This reference have two incidence studies (called Meguro 2007a and Meguro 2007b for this review). In the 2005 study (Meguro 2007b), 281 patients without MRI results were analysed Exclusion criteria: not reported
Patient characteristics and setting	A total of 281 participants with MCI ('questionable dementia') diagnosed with CDR = 0.5 (Morris 1993) were included in 2005 study. Those participants were recruited from the same community based population. Demographic data presented for the MCI‐converters (n=133; Table 1, p178) was provided for both studies (Meguro 2007a and Meguro 2007b): Gender: 45 M; 88 F Age: 9 aged 65 to 69 years; 77 aged 70 to 79 years; 47 aged 80+ Sources of recruitment: community of Tajiri, Japan
Index tests	Mini‐Mental state Examination (MMSE): Folstein version (1975, reference 25). A team of trained psychologist performed MMSE blindly to the diagnosis and CDR Threshold: “Abnormal MMSE data are assessed with reference to the participants’ educational levels based on the old Japanese education system: 17/18 for 6 (or less) years of schooling, 20/21 for 8 years of schooling, and 23/24 for 10 (or more) years of schooling” (information provided from the author) Cut off: ˂ 17 or ˂ 20 or ˂ 23
Target condition and reference standard(s)	Target condition: conversion from MCI to dementia Reference standard: DSM‐IV and CDR 1 +. A clinical team comprising medical doctors and public health nurses determined the follow‐up CDR blindly to the previous CDR stages, baseline cognitive test scores, and MRI data
Flow and timing	Participants 2005 (at baseline): N = 281 Duration of follow‐up: 7 years At follow‐up: 113 MCI‐dementia: 26 with abnormal MMSE (at baseline); 168 MCI‐stable: 14 with abnormal MMSE (at baseline) (information from the author) TP = 26; FN = 87; FP = 14; TN = 154 Sensitivity = 23%; Specificity = 92% (calculated in RevMan5) Loss to follow‐up: none
Comparative
Notes	The trial investigators were contacted; they provided requested data tor the 2 X 2 table to be completed; e‐mail from Dr Meguro on 4 March 2014
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?	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?	Yes
Were MMSE results interpreted without knowledge of the reference standard?	Yes
Were MMSE thresholds prespecified?	Unclear
			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?	Yes