Calvin Hirsch, MD
Do 3 brief cognitive screening tests in primary care perform as well as a longer test for detecting cognitive impairment without dementia (CIND) or dementia in elderly persons?
Blinded comparison of 3 brief and 1 longer screening test, with independent diagnosis of CIND or dementia.
3 Veterans Affairs primary care clinics in North Carolina, USA.
630 community-dwelling patients ≥ 65 years of age (mean age 75 y, 93% men) who had no recorded diagnosis of dementia or psychotic illness, unstable medical conditions, or severe hearing or visual impairment; and ≥ 2 clinic visits in the past 18 months.
A research assistant administered, in random order: 1) Modified Mini-Mental State Examination (3MS) with additional memory, verbal fluency, similarities, and delayed recall items (17 min; score < 83/100 = impairment); 2) Mini-Cog consisting of a 3-item recall and a clock-drawing test (3 min; score < 3/5 = probable impairment); 3) Memory Impairment Screen (MIS) consisting of a 4-word recall after an interference task (4 min; score < 5/8 = impairment); and 4) a 2-question functional memory screen (MF-2) (1.5 min; 2 yes answers = impairment).
A research nurse conducted semistructured clinical interviews with participants and informants; neuropsychological testing and neurologic examination; and review of electronic medical records. Based on this information, a panel of 3 clinicians assigned 1 of 3 diagnoses: CIND (cognitive impairment that did not meet criteria for dementia, or ≥ 1 neuropsychological measure ≥ 1.5 standard deviations below published norms); dementia (based on standardized criteria, e.g., DSM-IV); or normal cognitive function.
Sensitivity, specificity, and likelihood ratios.
21 patients (3.3%) had dementia, and 247 (39%) had CIND. For detection of dementia or dementia-or-CIND, 3MS had higher sensitivity and lower specificity than MIS or MF-2 (all P < 0.02, Table). For detection of dementia or dementia-or-CIND, 3MS had similar sensitivity (both P > 0.4) but higher specificity (both P≤ 0.002) than Mini-Cog (Table).
1 of 3 brief screening tools (Mini-Cog) had sensitivity similar to the longer Modified Mini-Mental State Examination for detecting dementia or cognitive impairment without dementia in elderly patients in primary care.
Test characteristics of screening instruments to detect dementia or cognitive impairment with no dementia (CIND) in elderly patients*
*3MS = modified Mini-Mental State Examination; MF-2 = 2-item functional memory screen; MIS = Memory Impairment Screen; diagnostic terms defined in Glossary.
Hirsch C. The Mini-Cog had sensitivity similar to the longer 3MS for detecting cognitive impairment or dementia. Ann Intern Med. ;157:JC4–8. doi: 10.7326/0003-4819-157-8-201210160-02008
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Published: Ann Intern Med. 2012;157(8):JC4-8.
Dementia, Geriatric Medicine, Neurology, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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