COGNITIVE TESTS TO DETECT MILD COGNITIVE IMPAIRMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Mild cognitive impairment (MCI) is prevalent and is a syndrome of increased risk for dementia. The Montreal Cognitive Assessment (MoCA) is designed for MCI detection, but many other cognitive tests are available for MCI screening. This study would evaluate the diagnostic performance of different cognitive tests for the detection of MCI. A list of cognitive tests was identified in previous reviews and from the online search engines. Literature searches were performed on each of the cognitive tests in MEDLINE, EMBASE, and PsycINFO from the earliest available dates stated in the individual databases until September 30, 2016. We also extended our search in Google Scholar as a supplementary search. Cross-sectional studies to assess the diagnostic performances of cognitive tests were extracted with the inclusion and exclusion criteria. The test performances were compared with standard diagnostic criteria. Bivariate random-effects models were used to summarize the test performances as a point estimate for sensitivity and specificity, and presented in a summary receiver-operating characteristic curve. Reporting quality and risk of bias were evaluated. A total of 97 studies with 21,918 participants were identified to evaluate 9 cognitive tests for detection of MCI. Most studies used the MMSE (n=51) and the MoCA (n=31). The combined performance on MMSE for detection of MCI were 0.71 sensitivity (95% CI: 0.67–0.76) and 0.75 specificity (95% CI: 0.70–0.79). The combined performance on MoCA were 0.83 sensitivity (95% CI: 0.80–0.87) and 0.74 specificity (95% CI: 0.68–0.80). Among the other cognitive tests, the recall tests showed the best diagnostic performances with 0.89 sensitivity (95% CI, 0.84 - 0.93) and 0.83 specificity (95% CI, 0.76 − 0.88) (Figure 1). In subgroup analyses, the long or short delay recall tests are showed to be better than immediate recall tests. The MoCA showed better diagnostic performance than the MMSE in the detection of MCI. Although the recall tests only focused on memory functions, they demonstrated better diagnostic performance. Testing for memory functions is the most relevant domain for MCI screening. HSROC for the Pooled Sensitivity and Specificity of the Recall Test, MoCA and MMSE.