Brief Cognitive Tests Used in Primary Care Cannot Accurately Differentiate Mild Cognitive Impairment from Subjective Cognitive Decline
(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.
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- author
- Petrazzuoli, Ferdinando LU ; Vestberg, Susanna LU ; Midlöv, Patrik LU ; Thulesius, Hans LU ; Stomrud, Erik LU and Palmqvist, Sebastian LU
- organization
- publishing date
- 2020-06
- 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 < 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.</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}}, }