Xu 2002

Study characteristics
Patient sampling	Retrospective cohort of 351 consecutive patients attending outpatient research clinic, admitted between 1992 and 1997 and referred by specialists, primary care physicians or self‐referred Exclusion criteria: subjects with pre‐existing dementia, non‐dementing organic brain disorders, epilepsy, previous strokes and infectious central nerve system diseases
Patient characteristics and setting	351 participants with subjective memory complaints Gender:140 M; 211 F Age: mean age 67 years (SD 11.23) APOE4 carrier: not provided Resources of referral: specialists and primary care physicians; in addition, many relatives, friends and caregivers volunteered to participate (self‐referrals) Resources of recruitment: outpatient research clinic, Houston and Southwest United States
Index tests	Mini‐Mental state Examination (MMSE): full details about version. Unclear who administered and interpreted the test. Used threshold was not pre‐specified
Target condition and reference standard(s)	Target condition: conversion from SMC to Alzheimer's disease dementia, vascular dementia, dementia by Lewy bodies or frontotemporal dementia Reference standard: for AD = NINCDS‐ADRDA; VaD = NINDS‐AIREN; DLB = McKeith criteria; FTD = Lund and Manchester criteria
Flow and timing	Duration of follow‐up: 3 to 6 years (mean 3.89 ± 2.17 years) Number included in analyses: 351 1) Conversion to probable AD: N = 47 probable AD and 304 non‐AD (37 non‐AD dementias and 267 MCI stable); disease positive = 47; disease negative = 304 Sensitivity: 61%; Specificity: 82.9%; cut‐off: ≤ 26 (27/26 scores) (Table 2, p1030) TP = 29; FP = 52; FN = 18; TN = 252 (calculated in RevMan5) 2) Conversion to probable VaD: N = 22 probable VaD and 329 non‐VaD (62 non‐VaD dementias and 267 MCI stable): disease positive = 22; disease negative = 329 Sensitivity: 36.4%; Specificity: 80%; cut‐off: ≤ 25 (26/25 scores) (Table 3, p1030) TP = 8; FP = 65; FN = 14; TN = 264 (calculated in RevMan5) 3) Conversion to all dementias: N = 84 all dementia and 267 non‐converters (267 MCI stable): disease positive = 84; disease negative = 267 Sensitivity: 57.1%; Specificity: 85.8%; cut‐off: ≤ 26 (27/26 scores) (Table 4, p1030) TP = 48; FP = 38; FN = 36; TN = 229 (calculated in RevMan5) Loss to follow‐up: all participants who completed at least three years of longitudinal cognitive assessment were included in the analysis
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?	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?	Yes
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
			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