Recall Tests Are Effective to Detect Mild Cognitive Impairment: A Systematic Review and Meta-analysis of 108 Diagnostic Studies

Abstract

BackgroundMild cognitive impairment (MCI) is a prevalent symptom associated with the increased risk of dementia. There are many cognitive tests available for detection of MCI, and investigation of the diagnostic performance of the tests is deemed necessary. ObjectiveThis study aims to evaluate the diagnostic performance of different cognitive tests used for MCI detection. Data sourcesA list of cognitive tests was identified in previous reviews and from online search engines. Literature searches were performed on each of the cognitive tests in MEDLINE, Embase, and PsycINFO from the earliest available dates of individual databases to December 31, 2016. Google Scholar was used as a supplementary search tool. Study selectionStudies that were used to assess the diagnostic performance of the cognitive tests were extracted with inclusion and exclusion criteria. Each test's performance was compared with the standard diagnostic criteria. Bivariate random effects models were used to summarize the test performance 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. ResultsA total of 108 studies with 23,546 participants were selected to evaluate 9 cognitive tests for MCI detection. Most of the studies used the Mini-Mental State Examination (MMSE) (n = 58) and the Montreal Cognitive Assessment (MoCA) (n = 35). The combined diagnostic performance of the MMSE in MCI detection was 0.71 sensitivity [95% confidence interval (CI): 0.66–0.75] and 0.74 specificity (95% CI: 0.70–0.78), and of the MoCA in MCI detection was 0.83 sensitivity (95% CI: 0.80–0.86) and 0.75 specificity (95% CI: 0.69–0.80). Among the 9 cognitive tests, recall tests showed the best diagnostic performance with 0.89 sensitivity (95% CI: 0.86–0.92) and 0.84 specificity (95% CI, 0.79–0.89). In subgroup analyses, long- or short-delay recall tests have shown better performance than immediate recall tests. ConclusionsRecall tests were shown to be the most effective test in MCI detection, especially for the population with symptoms of memory deterioration. They can be potentially used as the triage screening test for MCI in primary care setting. But when a patient shows cognitive impairments beyond memory deterioration, a more comprehensive test such as the MoCA should be used.