The comparative diagnostic accuracy of the Mini Mental State Examination (MMSE) and the General Practitioner assessment of Cognition (GPCOG) for identifying dementia in primary care: a systematic review protocol

Mark Pearson,Harriet A Hunt,Christopher J Hyde,Yemisi Takwoingi,Sanne Van Kampen,David J Llewellyn

doi:10.1186/s41512-017-0014-1

Abstract

BackgroundImproved dementia identification is a global health priority, and general practitioners (GPs) are often the first point of contact for people with concerns about their cognition. However, GPs often express uncertainty in using assessment tools and the evidence based on which tests are most accurate in identifying dementia is unclear. In particular, there is little certainty around how the accuracy of available brief cognitive assessments compares within a clinical family practice setting.Grounded in existing brief cognitive assessment evidence, we will compare the diagnostic test accuracy of the Mini Mental State Examination (MMSE) to the General Practitioner Assessment of Cognition (GPCOG) against the best available reference standard when used within a family practice setting.MethodsWe will employ robust systematic review methods to assess studies of diagnostic accuracy where both the MMSE and GPCOG have been evaluated as direct comparisons, i.e. within the same study population. This approach will enable us to minimise between-study heterogeneity, to eliminate the risk of bias due to confounding and increase the opportunity to make clinically useful and useable comparisons of diagnostic accuracy across both the MMSE and GPCOG. This systematic review will be conducted using a pragmatic search strategy, refining searches that build upon studies identified as part of our overview of systematic reviews of the diagnostic accuracy of brief cognitive assessments for identifying dementia in primary care.DiscussionThrough this systematic review, we aim to improve existing evidence on how the diagnostic accuracy of MMSE and GPCOG compares when used to identify dementia within the family practice setting. We also aim to make clinical practice recommendations based upon the variations in diagnostic accuracy identified between the MMSE and GPCOG.

Highlights

Improved dementia identification is a global health priority, and general practitioners (GPs) are often the first point of contact for people with concerns about their cognition
In an overview of systematic reviews of the diagnostic accuracy of brief cognitive assessments for identifying dementia in primary care, we identified two brief cognitive assessments that can be compared to identify the test with better diagnostic performance
The primary outcome is the comparative accuracy of the two tests assessed via direct comparisons, i.e. the diagnostic accuracy of the two tests are compared within the same population in a study

Summary

Introduction

Improved dementia identification is a global health priority, and general practitioners (GPs) are often the first point of contact for people with concerns about their cognition. Grounded in existing brief cognitive assessment evidence, we will compare the diagnostic test accuracy of the Mini Mental State Examination (MMSE) to the General Practitioner Assessment of Cognition (GPCOG) against the best available reference standard when used within a family practice setting. Examples are available in the UK from the National Institute for Health and Care Excellence [9] and the Royal College of Psychiatrists [10], and in the Netherlands from the Huisartsen Genootschap (GP Society) [11] These all include the Mini Mental State Examination (MMSE) and the General Practitioner Assessment of Cognition (GPCOG)

Objectives

Methods

Conclusion