Abstract
BackgroundSubtle cognitive decline (SCD) may represent a very early stage of objective cognitive impairment before mild cognitive impairment (MCI), with less neuronal damage and more functional reservation. Detecting individuals with SCD is imperative for dementia prevention and treatment. In this study, we aimed to compare the validations of three cognitive screening tests, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment-Chinese Version (MoCA-CV), and Memory and Executive Screening (MES), in identifying subtle cognitive decline.MethodsA total of 407 individuals were recruited, including 147 cognitively normal controls (NC), 102 individuals with subtle cognitive decline (SCD) and 158 individuals with mild cognitive impairment (MCI) according to the operational neuropsychological criteria proposed by Jak and Bondi’s. All participants underwent standardized comprehensive neuropsychological tests and the three cognitive screening tests. Chi-square analysis was used to compare the cognitive performance among the groups of NC, SCD and MCI. Receiver operating characteristic (ROC) curves were used to evaluate the abilities of MMSE, MoCA-CV and MES in discriminating NC, SCD and MCI.ResultsCompared with NC, SCD showed a significant decline only in the tests of memory, such as Auditory Verbal Learning Test (AVLT), Rey-Osterrieth Complex Figure Test (CFT) and Prospective Memory Test (PrM) (P < 0.01). However, MCI showed significant decline in all cognitive performances (P < 0.01). The scores of MMSE, MoCA-CV and MES all showed a progressive downward trend within the groups of NC, SCD and MCI (P < 0.001). In ROC Analyses for discriminating individuals with SCD from NC, the most appropriate MES cutoff was 84, with a sensitivity of 74.3%, a specificity of 60.8% and 0.738 for AUC (95%CI, 0.675–0.801). By contrast, MMSE and MOCA-CV had poor sensitivity (67.4 and 70.8%, respectively) and specificity (51.0 and 52.9%, respectively), and smaller AUCs (0.643 and 0.644, respectively) than the MES.ConclusionAs a screening test, MES is more efficacious in identifying SCD from normal controls than MMSE and MoCA-CV.
Highlights
Subtle cognitive decline (SCD) may represent a very early stage of objective cognitive impairment before mild cognitive impairment (MCI), with less neuronal damage and more functional reservation
Besides the common inclusion criteria, all the controls had no significant impairment in cognitive functions, preserved in activities of daily living, had no memory complaints verified by informants, Clinical Dementia Rating (CDR) score = 0, Hamilton depression rating scale (17-item) score ≤ 12
Demographics and standardized neuropsychological tests among NC, SCD, MCI A total of 407 participants were included in our analysis, including 147 cognitively normal controls (NC), 102 individuals with SCD and 158 individuals with MCI according to the criteria of Jak and Bondi’s [13, 21]
Summary
Subtle cognitive decline (SCD) may represent a very early stage of objective cognitive impairment before mild cognitive impairment (MCI), with less neuronal damage and more functional reservation. As a result, detecting individuals with a stage of less neuronal damage and more functional reservation is imperative for dementia prevention and treatment [3, 4]. Subtle cognitive decline (SCD), one of the markers which were used to define the preclinical stages of AD according to the National Institute on Aging and Alzheimer’s Association (NIA-AA) [5], may represent very subtle neurobehavioral changes occurred years before meeting the criteria for MCI. With the improvement of education level in the world today, increasing cognitive reserve makes individuals with certain pathological changes more likely to appear as SCD than prominent cognitive impairment
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