A systematic review of short cognitive assessments for diagnosing dementia and MCI in clinical settings in Chinese‐speaking countries

Abstract

AbstractBackgroundMandarin Chinese is one of the most widely spoken languages in the world, and is used as a primary or secondary language in China, Hong Kong, Singapore and Taiwan. These countries differ in historical, economic and societal contexts so that cognitive assessments validated in one country may not be valid in another. The aims of this study are to compare the short diagnostic assessments (<15 minutes) used to assist in diagnosing dementia and Mild cognitive impairment (MCI) in Chinese‐speaking countries through rating the translation and cultural adaptation and reporting the sensitivity and specificity of assessments.MethodWe searched for terms relating to "assessments" and "dementia" or "MCI" and "Chinese‐speaking populations” in electronic bibliographic databases, including Embase, Ovid MEDLINE(R), PsycINFO, PsycTESTS, Web of Science, The Cochrane Library from inception to 3th July 2019. Two raters independently screened titles and abstracts, rated the translation and cultural adaption according to published guidelines by judging whether the details described are sufficient for replication and evaluated the quality of studies with a diagnostics critical appraisal sheet developed by the Centre for Evidence‐Based Medicine (CEBM).ResultThe searches retrieved 11763 articles, of which 74 articles were included after full‐text screening: 29 articles from China, 18 articles from Hong Kong, 12 articles from Singapore and 15 articles from Taiwan. We found 41 different short cognitive assessments used, but only two assessments ‐ the Mini‐Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) have been validated in the four countries. The NUCOG cognitive screening tool in China specifically was shown to have the highest validity in screening 44 dementia diagnosed with DSM‐IV from 260 normal controls with a sensitivity of 100% and specificity of 98.5%. Reporting of cultural adaptation was achieved in approximately two third of the studies analysed.ConclusionThere are wide range of tools available to assess cognitive impairment in the Chinese‐speaking populations most of them are not validated in all Chinese speaking populations. Their psychometric properties vary and translation and cultural adaptation procedures are poorly reported.