Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Brief Cognitive Tests Used in Primary Care Cannot Accurately Differentiate Mild Cognitive Impairment from Subjective Cognitive Decline

Petrazzuoli, Ferdinando LU orcid ; Vestberg, Susanna LU ; Midlöv, Patrik LU orcid ; Thulesius, Hans LU ; Stomrud, Erik LU orcid and Palmqvist, Sebastian LU orcid (2020) In Journal of Alzheimer's disease : JAD 75(4). p.1191-1201
Abstract

BACKGROUND: Differentiating mild cognitive impairment (MCI) from subjective cognitive decline (SCD) is important because of the higher progression rate to dementia for MCI and when considering future disease-modifying drugs that will have treatment indications at the MCI stage.

OBJECTIVE: We examined if the two most widely-used cognitive tests, the Mini-Mental State Examination (MMSE) and clock-drawing test (CDT), and a test of attention/executive function (AQT) accurately can differentiate MCI from SCD.

METHODS: We included 466 consecutively recruited non-demented patients with cognitive complaints from the BioFINDER study who had been referred to memory clinics, predominantly from primary care. They were classified as MCI... (More)

BACKGROUND: Differentiating mild cognitive impairment (MCI) from subjective cognitive decline (SCD) is important because of the higher progression rate to dementia for MCI and when considering future disease-modifying drugs that will have treatment indications at the MCI stage.

OBJECTIVE: We examined if the two most widely-used cognitive tests, the Mini-Mental State Examination (MMSE) and clock-drawing test (CDT), and a test of attention/executive function (AQT) accurately can differentiate MCI from SCD.

METHODS: We included 466 consecutively recruited non-demented patients with cognitive complaints from the BioFINDER study who had been referred to memory clinics, predominantly from primary care. They were classified as MCI (n = 258) or SCD (n = 208) after thorough neuropsychological assessments. The accuracy of MMSE, CDT, and AQT for identifying MCI was examined both in training and validation samples and in the whole population.

RESULTS: As a single test, MMSE had the highest accuracy (sensitivity 73%, specificity 60%). The best combination of two tests was MMSE < 27 points or AQT > 91 seconds (sensitivity 56%, specificity 78%), but in logistic regression models, their AUC (0.76) was not significantly better than MMSE alone (AUC 0.75). CDT and AQT performed significantly worse (AUC 0.71; p < 0.001-0.05); otherwise no differences were seen between any combination of two or three tests.

CONCLUSION: Neither single nor combinations of tests could differentiate MCI from SCD with adequately high accuracy. There is a great need to further develop, validate, and implement accurate screening-tests for primary care to improve accurate identification of MCI among individuals that seek medical care due to cognitive symptoms.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Alzheimer's disease : JAD
volume
75
issue
4
pages
11 pages
publisher
IOS Press
external identifiers
  • scopus:85090484358
  • pmid:32417771
ISSN
1387-2877
DOI
10.3233/JAD-191191
language
English
LU publication?
yes
id
ee334c4e-2c7f-4248-9226-6bd2a4148c3f
date added to LUP
2020-05-24 20:11:15
date last changed
2024-04-17 09:34:07
@article{ee334c4e-2c7f-4248-9226-6bd2a4148c3f,
  abstract     = {{<p>BACKGROUND: Differentiating mild cognitive impairment (MCI) from subjective cognitive decline (SCD) is important because of the higher progression rate to dementia for MCI and when considering future disease-modifying drugs that will have treatment indications at the MCI stage.</p><p>OBJECTIVE: We examined if the two most widely-used cognitive tests, the Mini-Mental State Examination (MMSE) and clock-drawing test (CDT), and a test of attention/executive function (AQT) accurately can differentiate MCI from SCD.</p><p>METHODS: We included 466 consecutively recruited non-demented patients with cognitive complaints from the BioFINDER study who had been referred to memory clinics, predominantly from primary care. They were classified as MCI (n = 258) or SCD (n = 208) after thorough neuropsychological assessments. The accuracy of MMSE, CDT, and AQT for identifying MCI was examined both in training and validation samples and in the whole population.</p><p>RESULTS: As a single test, MMSE had the highest accuracy (sensitivity 73%, specificity 60%). The best combination of two tests was MMSE &lt; 27 points or AQT &gt; 91 seconds (sensitivity 56%, specificity 78%), but in logistic regression models, their AUC (0.76) was not significantly better than MMSE alone (AUC 0.75). CDT and AQT performed significantly worse (AUC 0.71; p &lt; 0.001-0.05); otherwise no differences were seen between any combination of two or three tests.</p><p>CONCLUSION: Neither single nor combinations of tests could differentiate MCI from SCD with adequately high accuracy. There is a great need to further develop, validate, and implement accurate screening-tests for primary care to improve accurate identification of MCI among individuals that seek medical care due to cognitive symptoms.</p>}},
  author       = {{Petrazzuoli, Ferdinando and Vestberg, Susanna and Midlöv, Patrik and Thulesius, Hans and Stomrud, Erik and Palmqvist, Sebastian}},
  issn         = {{1387-2877}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{1191--1201}},
  publisher    = {{IOS Press}},
  series       = {{Journal of Alzheimer's disease : JAD}},
  title        = {{Brief Cognitive Tests Used in Primary Care Cannot Accurately Differentiate Mild Cognitive Impairment from Subjective Cognitive Decline}},
  url          = {{http://dx.doi.org/10.3233/JAD-191191}},
  doi          = {{10.3233/JAD-191191}},
  volume       = {{75}},
  year         = {{2020}},
}