Table 1.
Reference, Country | Number of studies included in systematic review | Intervention(s) | Comparator | Cognitive outcome(s) measured | Time of administration (minutes) | Sensitivity (%) | Specificity | Conclusions | Abbreviations |
---|---|---|---|---|---|---|---|---|---|
Mitchell et al, United Kingdom | 44 |
Multidomain screening tests (known as a battery detection method) in primary care which assess for multiple cognitive domains. Primary care case-finding † : ▪AMTS/MSQ, ▪MSQ ▪WIND-SET ▪PCL ▪AMTS ▪PCL Primary care screening ‡ : ▪ PCL ▪AMTS/MSQ ▪MSQ ▪SPMSQ ▪GPCOG |
MMSE | Dementia |
Primary care case-finding: ▪AMTS/MSQ = 4 ▪MSQ = 2 ▪WIND-SET = 1 ▪PCL = 11 ▪AMTS = 2 ▪PCL = 11 Primary care screening: ▪PCL = 11 ▪AMTS/MSQ = 4 ▪MSQ = 2 ▪SPMSQ = 2 ▪GPCOG = 5 Comparator: ▪MMSE = 9 with healthy individuals and 15 with patients with dementia. |
Battery detection methods: ▪84.0 (95% CI 74.2–91.8) |
Battery detection methods: ▪89.9 (95% CI 78.3–97.4) |
The optimal individual tools were the AMTS/MSQ and PCL. AMTS was superior to the MMSE for case finding however the MMSE was optimal for screening. |
AMTS/MSQ-Abbreviated Mental Test Score/Mental Status Questionnaire, (WIND-SET)-Specific Set of items from MMSE, PCL-Prueba cognitive de leganes, AMTS-Abbreviated mental test score, GPCOG-General practitioner’s assessment of cognition, MMSE-Mini-Mental State Examination † Case-finding is defined as any tool or questionnaire which identifies a condition with minimal false negatives, measured as the positive predicative value. ‡ Screening is the ability of a test to rule out a diagnosis with minimal false positives, reported as the negative predictive value. |
Creavin et al, United Kingdom | 70 | ▪MMSE | A commonly accepted clinical (gold) reference standard. | Dementia | ▪MMSE=7 with a patient with dementia and 5 with a person with normal cognition |
Carnero-Pardo 2013: ▪Cut point of 17 = 70 (95% CI 59-80) ▪Cut point of 24 = 100 (95% CI 95-100) |
Carnero-Pardo 2013: ▪Cut point of 17 = 93 (95% CI 89, 96) ▪Cut point of 24 = 46 (95% CI 40-52) |
Carnero-Pardo 2013 reported there were some false negatives as the sensitivity fell from 1.00 (95% CI 0.95 to 1.00) to 0.70 (95% CI 0.59 to 0.80). The summary diagnostic accuracy could not be estimated due to insufficient data. | |
Abd Razak et al, Malaysia | 30 |
▪MoCA-B; MoCA ▪SPMSQ ▪MEFO ▪ACE-III ▪AQT-CF ▪SLUMS ▪5 Object Test ▪BNB Semantic Fluency ▪SMCC compared to MMSE and CDT ▪CASI-S ▪RCS ▪CPS ▪Literacy Independent Cognitive Assessment ▪BIMS; BCAT ▪3MS ▪Mini-Cog; MIS; MF-2 ▪VT-VSM; VR-DOT ▪CCS ▪CAMCI ▪CADi; CADi-2 ▪DRA ▪p-AD8 ▪IQCODE |
Comparing the feasibility and validity between the various screening tools. | Mild cognitive impairment and dementia |
▪MoCA-B = 15-21; MoCA = 10-15 ▪SPMSQ = 10-15 ▪MEFO = 10-15 ▪ACE-III = 15 ▪AQT-CF = 3-5 ▪SLUMS = 7 ▪5 Object Test = <5 ▪BNB Semantic Fluency = 31 ▪MCC compared to MMSE and CDT = NR ▪CASI-S = NR ▪RCS = <3 ▪CPS = NR ▪Literacy Independent Cognitive Assessment = 20 ▪BIMS = 3; BCAT = 10-15 ▪3MS = 17 ▪Mini-Cog = 3; MIS = 4; MF-2 = <2 ▪VT-VSM = >12; VR-DOT = NR ▪CCS = 3 ▪CAMCI = 30 ▪CADi = 10; CADi-2 = 10-40 ▪DRA = NR ▪p-AD8 = NR ▪IQCODE = 10 |
For detecting dementia: ▪ACE-III at a cut-off point of <81, Sn = 100 For detecting MCI: ▪MoCA, Sn = 91-97 |
For detecting dementia: ▪ACE-III at a cut-off point of <81, Sp=96 For detecting MCI: ▪MoCA, Sp = 60-80 |
For detecting dementia: Screening tools less sensitive to ACE-III but with relatively high Sn/Sp values were: SLUMS, RCS, and BCAT. For detecting MCI: The MoCA was the most commonly used tool and had the highest Sn/Sp ranges. Less specific to the MoCA but among the most sensitive tools were the (VR-DOT) and IQCODE. Tools with the highest specificity but with lower sensitivity were: The 5 Objects Test, RCS, CPS, and (VT-VSM). |
NR-Not Reported, MCI-Mild Cognitive Impairment, (MoCA-B)-Montreal Cognitive Assessment-Basic, (MoCA)-Montreal Cognitive Assessment, SPMSQ-Short Portable Mental Status Questionnaire, (MEFO)-Memory, fluency and orientation, (ACE-III)-Addenbrooke's Cognitive Examination III, (AQT-CF)-A Quick Test of Cognitive Speed, (SLUMS)- Saint Louis University Mental Status, (BNB)-Brief Neuropsychological Battery Semantic Fluency, (SMCC)-The Subjective Memory Complaint Clinical, (CASI-S)-Cognitive Abilities Screening Instrument-Short, (RCS)-Rapid Cognitive Screen, (CPS)-Cognitive Performance Scale, (BIMS)-Brief Interview for Mental Status, (BCAT)-Brief Cognitive Assessment Tool, (3MS)-Modified Mini-Mental State Examination, (MIS)-Memory Impairment Screen, (MF-2)-Memory Function 2, (VT-VSM)-Virtual Reality technology: Virtual supermarket, (VR-DOT)-Virtual Reality Day-Out-Task, (CCS)-Computerized Cognitive Screening Tests, (CAMCI)-Computerized Assessment of Mild Cognitive Impairment, (CADi)-[Cognitive Assessment for Dementia, iPad version], (CADi-2)-[Revised Cognitive Assessment for Dementia, iPad version], (DRA)-Dementia Risk Assessment, (p-AD8)-Participant-rated, (IQCODE)- Informant Questionnaire on Cognitive Decline in the Elderly individuals |
Smith et al, United Kingdom | 33 |
▪Rural Older Adult Memory Evaluation ▪Mini-Cog ▪PRISM-PC ▪SAPH questionnaire ▪MMSE and clinical history/examination ▪7-minute screen ▪CIE and MMSE |
Not mentioned. | Dementia | Not mentioned. | Not mentioned. | Not mentioned. | There is insufficient evidence to support the adoption of these programmes into practice. Six positive and eight negative effects of primary care screening and early diagnosis of dementia were reported. | (PRISM-PC)-Perceptions Regarding Investigational Screening for Memory in Primary Care, SAPH-Dementia Screening and Perceived Hames, CIE-The Canberra Interview for the Elderly |
Brodaty et al, Australia | 83 |
Instruments Validated in General Practice, Community or Population Samples: ▪AMT ▪Cambridge Cognitive Examination ▪CDT ▪GPCOG ▪Mini-Cog ▪MIS ▪MMSE ▪Short and Sweet Screening Instrument ▪Short IQCODE |
MMSE | Dementia |
▪AMT = 3:16 ▪Camnridge Cognitive Examination = 20 ▪CDT = 2:16 ▪GPCOG = 4.5 ▪Mini-Cog = 2-4 ▪MIS = 4 ▪MMSE = 4 ▪Short and Sweet Screening Instrument = 10 ▪Short IQCODE = 30s |
Screening tests validated in general practice, community or population samples: ▪AMT-100 (95% CI 70-100) ▪Cambridge Cognitive Examination-88 (95% CI 64-99) ▪CDT-76 (95% CI 60-88) ▪GPCOG-85 (95% CI 76-92) ▪Mini-Cog-76 (95% CI 65-85) ▪MIS-80 (95% CI 66-90) ▪MMSE-69 (95% CI 66-73) ▪Short and Sweet Screening Instrument-94 (95% CI 88-96) ▪Short IQCODE-79 (95% CI 65-90) |
Screening tests validated in general practice, community or population samples: ▪AMT-82 (95% CI 72-90) ▪Cambridge Cognitive Examination-75 (95% CI 67-83) ▪CDT-81 (95% CI 77-84) ▪GPCOG-86 (95% CI 81-91) ▪Mini-Cog-89 (95% CI 87-91) ▪MIS-96 (95% CI 94-98) ▪MMSE-89 (95% CI 87-92) ▪Short and Sweet Screening Instrument-91 (95% CI 90-92) ▪Short IQCODE-82 (95% CI 79-85) |
Screening tests validated in general practice, community or population samples: AMT had a PPV=0.42 (95% CI), NPV=1.00 (95% CI), misclassification of 16%, had internal consistency and face validity. Mini-Cog had a PPV=0.34 (95% CI), NPV=0.98 (95% CI), 12% misclassification, no education bias or language/cultural bias, and had face validity*. The AMT, CDT, GPCOG, Short IQCODE, Mini-Cog, and MIS all had a NPV =< MMSE (0.92). The GPCOG, Mini-Cog and MIS had a misclassification rate =< MMSE (15%) and had a high sensitivity and specificity (>=80%) and were therefore chosen as the most suitable instruments for use in general practice. |
MAT-Mental Alternation Test. *- (Based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria requiring that instruments test memory and at least one other cognitive domain). CDT-Clock Drawing Test. GPCOG-General Practitioner Assessment of Cognition. |
Seitz et al, Canada | 4 | The Mini-Cog performed in insolation or scored based on results on the CDT or three-word recall | Standard diagnostic criteria for the clinical diagnosis of dementia | Alzheimer's disease dementia and related dementias | Mini-Cog = 3-5 in routine practice |
Carnero-Pardo 2013 dementia prevalence was 34.5%: ▪100 (95% CI 93-100) Fuchs 2012 5.0% dementia prevalence: ▪100 (95% CI 84-100) Holsinger 2012 (highest quality study) 5.5% dementia prevalence: ▪76 (95% CI 53-92) McCarten 2012 90.3% dementia prevalence: ▪84 (95% CI 81-87) |
Carnero-Pardo 2013: ▪40 (95% CI 30-50) Fuchs 2012: ▪85 (95% CI 81-89) Holsinger 2012: ▪73 (95% CI 68-77) McCarten 2012: ▪27 (95% CI 16-41) |
Presently there is insufficient evidence to support the use of Mini-Cog in primary care. Studies mentioned are primary journal articles (cross-sectional studies). |
|
Cullen et al, United Kingdom | 36 |
▪3MS ▪CASI ▪MMSE ▪SASSI ▪STMS ▪CAST ▪GPCOG ▪7MS ▪AMT ▪Mini-Cog ▪SIS ▪T&C ▪ACE-R ▪DemTect |
Gold standard diagnostic criteria (based on international diagnostic guidelines or clinical judgement following a full assessment battery). | Cognitive impairment or any type of dementia |
▪3MS = 10-15 ▪CASI = 15-20 ▪MMSE = 8-13 ▪SASSI = 10-15 ▪STMS = 5 ▪CAST = 15 ▪GPCOG = 5 ▪7MS = 7-15 ▪AMT = 5 ▪Mini-Cog = 3-4 ▪SIS = 5 ▪T&C = 1 ▪ACE-R = 16 ▪DemTect = 8-10 |
▪3MS = 83-94 ▪CASI = 91-95 ▪MMSE = 69-91 ▪SASSI = 94 ▪STMS = 86-95 ▪CAST = 88-95 ▪GPCOG = 85 ▪7MS = 91 ▪AMT = 73-100 ▪Mini-Cog = 76-99 ▪SIS = 81-89 ▪T&C = 63-95 ▪ACE-R = 84-94 ▪DemTect = 100 (Alzheimer's dementia) |
▪3MS = 85-90 ▪CASI = 37-97 ▪MMSE = 87-99 ▪SASSI = 81-91 ▪STMS = 88-94 ▪CAST = 88-100 ▪GPCOG = 86 ▪7MS = 94 ▪AMT = 71-100 ▪Mini-Cog = 89-93 ▪SIS = 88-91 ▪T&C = 54-96 ▪ACE-R = 89-100 ▪DemTect = 92 (Alzheimer's dementia) |
These tests were selected as brief assessment tools in the doctor's office due to their reported sensitivity and specificity values that were >85% for all dementia types together or for more than one particular subtype alone, and/or they covered at least three key domains. The 3MS and CASI are the only tests which cover all six key abilities (Attention/working memory, verbal recall, expressive language, verbal fluency, visual construction, reasoning/judgement). |
(ACE-R)-Addenbrooke's Cognitive Examination Revised, STMS-Short Test of Mental Status, CCSE-Cognitive Capacity Screening Examination, (R-CAMCOG)-Rotterdam Version of the Cambridge Cognitive Examination |
Lischka et al, Canada | 12 |
▪MIS ▪IST, BVRT ▪CAMCI ▪ACE ▪ADAS-Cog ▪CAMCOG ▪MoCA ▪S-MMSE ▪IQCODE ▪STMS ▪MMSE ▪HDS-R ▪CCSE |
A full clinical examination as the reference standard. | Dementia, MCI, amnestic MCI, mild dementia, and questionable dementia. |
▪MIS, IST = 4 ▪IST, BVRT = 1 ▪CAMCI = 15 ▪ACE = 15 ▪ADAS-Cog = NR ▪CAMCOG = 20 ▪MoCA = 10-12 ▪S-MMSE = 10 ▪IQCODE = 10-20 ▪STMS = 5 ▪MMSE = 5-10 ▪HDS-R = NR ▪CCSE = 10-12 |
▪MIS, IST = 74 ▪IST, BVRT - Cutoff level 1 = 90.8 ▪CAMCI = 83.4 ▪ACE - Cutoff <88/100 = 100 ▪ADAS-Cog - Cutoff <75/100 = 85 ▪CAMCOG = 76 for memory section ▪MoCA = 94 ▪S-MMSE = 14 ▪IQCODE = 41 ▪STMS = ≤ 80 ▪MMSE = 31 ▪HDS-R = 92 for the dementia diabetic group ▪CCSE - Cutoff 26/25 = 88.1 |
▪MIS = 84, IST = 81 ▪IST, BVRT - Cutoff level 1 = 52.2 ▪CAMCI = 78.5 ▪ACE - Cutoff <88/100 = 43 ▪ADAS-Cog - Cutoff <75/100 = 83 ▪CAMCOG = 96 for memory section ▪MoCA = 50 ▪S-MMSE = 100 ▪IQCODE = 67 ▪STMS = ≤ 80 ▪MMSE = 96 ▪HDS-R = 74 for the dementia diabetic group ▪CCSE - Cutoff 26/25 = 83.5 |
Tools with the highest specificity rates: ▪MMSE ▪S-MMSE Tests with the highest sensitivities: ▪HDS-R ▪ACE, which decreased depending on cut-off value ▪MoCA for the dementia group and 83% for the MCI group ▪CAMCI ▪CCSE ▪The combination of the MMSE, IST, and BVRT at 90.8% for the first cut-off level. The ACE demonstrated good diagnostic accuracy with AUC=0.98. Xu et al. (2002) found that the CCSE was the best predictive screen in MCI participants for diagnosing all dementia due to its high sensitivity (88.1%) and specificity (83.5%). |
(IST,BVRT)-Isaacs Set Test, Benton's Visual Retention Test. CAMCI-Chinese Abbreviated Mild Cognitive Impairment Test, (ADAS-Cog)-Alzheimer Disease Assessment Scale-Cognitive Subscale, (S-MMSE)-Standardized Mini-Mental State Examination, (HDS-R)-Hasegawa Dementia Scale-Revised, CCSE-Cognitive Capacity Screening Examination, CAMCOG-Cambridge Cognitive Examination |
Boustani et al, United States | 61 |
▪MMSE ▪FAQ ▪BIMC ▪BOMC ▪STMS |
DSM-IV | Dementia | Not mentioned. |
▪MMSE = 71-92 ▪FAQ = 90 ▪BIMC = 90 ▪BOMC = 69 ▪STMS = 81 |
▪MMSE = 56-96 ▪FAQ = 90 ▪BIMC = 65-90 ▪BOMC = 90 ▪STMS = 90 |
The MMSE has limited Sp when the cut-point is set for higher Sn. Accuracy of the MMSE changes based upon the patients age, education level and ethnicity and therefore requires adjustment when used. | BIMC-Blessed Information Memory Concentration; BOMC-Blessed Orientation Memory Concentration; FAQ-Functional Activities Questionnaire; STMS-Short Test of Mental Status; DSM-IV-Diagnostic and Statistical Manual of Mental Disorders, fourth edition |