Screening Instrument For Cognitive Impairment Research Articles

The clock drawing test is an important contribution to the Mini Mental State Examination in screening for cognitive impairment

The clock drawing test (CDT) and the Mini Mental State Examination (MMSE) are frequently used screening instruments for cognitive impairment, however, the precise contribution of the CDT to the MMSE is largely unknown. We studied patients with subjective cognitive impairment (SCI, n=481), mild cognitive impairment (MCI, n=628) and Alzheimer's disease (AD, n=1099). Discrimination between patients was examined with multiple logistic regression, adjusted for age, sex, and education. Four groups were constructed based on a normal/abnormal MMSE (cut-off <24/30) versus normal/abnormal CDT (cut-off ≤2/3). Visually rated medial temporal lobe atrophy (MTA) on CT was used as parameter of neurodegeneration. The CDT significantly contributed to the MMSE in discriminating SCI from both MCI and AD patients. Our four group analyses showed that of those patients with a normal MMSE and incorrectly classified as SCI, an abnormal CDT could significantly identify 10.0% as MCI and 13.2% as AD. Among those with an abnormal MMSE, the percentage AD patients shifted from 53.1% to 82.1% due to an abnormal CDT. Presence of an abnormal CDT was significantly related to MTA increase, regardless of the MMSE score. The CDT is an important additional screening tool to the MMSE. An abnormal CDT with a normal MMSE is an indicator for cognitive impairment. An abnormal CDT in combination with an abnormal MMSE can be considered as an indicator of disease progression.

Montreal cognitive assessment as a screening instrument for cognitive impairment in systemic lupus erythematosus patients without overt neuropsychiatric manifestations.

The Montreal Cognitive Assessment (MoCA) is an increasingly used screening tool for cognitive impairment. The aim of this study was to examine how MoCA performed in identifying cognitive impairment (CI) domains in SLE patients compared with formal standardized neuropsychological testing (NPT). Factors related to SLE disease, immunologic and psychological state associated with CI were also explored. This cross-sectional study recruited 50 SLE patients without overt neuropsychiatric manifestations from April 2017 to May 2018. The patients were evaluated with MoCA, formal NPT and the Depression, Anxiety, and Stress Scales (DASS) 42-item self-report questionnaire. Values of sensitivity and specificity were computed for different cut-offs of MoCA within each cognitive domain of NPT and descriptive analysis was used to identify the factors affecting cognitive function. The median score for MoCA was 27.5 (range 22-30). Using a MoCA cutoff of <26, 18 (36%) were identified to have CI using NPT compared to 8 (16%) using MoCA. The most frequently affected cognitive domain was executive functioning with 15 affected patients. Sensitivities and specificities of the MoCA range from 50% to 100% and 5.7% to 16.7%, respectively, across cognitive domains. A lower MoCA cutoff of <25 improve sensitivity of identifying impairment in executive functioning from 60% to 80%. In univariate analysis, DASS scores, disease activity, presence of antiphospholipid antibodies, presence of concurrent autoimmune disease, current, and cumulative corticosteroid therapy did not predict cognitive performance. MoCA may be a useful screening tool to identify the most frequently affected cognitive domain which is executive functioning using a lower cutoff of <25 in SLE patients without overt neuropsychiatric manifestations.

Evaluation of Cognitive Functions in Schizophrenic Patients with the Montreal Cognitive Assessment Scale and Mini-Mental State Examination

Schizophrenia is a complex neurodevelopmental disorder. Cognitive deficit is the central feature of the neurodevelopmental disorders. Cognitive impairment is related to social, functional, and clinical symptoms. The aim of this study was to investigate the clinical usability of the Montreal Cognitive Assessment (MoCA) as a screening instrument for cognitive impairment in schizophrenic patients alone, and in correlation with the Mini-Mental State Examination (MMSE). This clinical study included 31 patients diagnosed with schizophrenia. Patients were selected from Psychiatry Clinic. For the assessment of cognitive impairment, we used Montreal Cognitive Assessment Scale (MoCA) and Mini-Mental State Examination (MMSE). Of the total number of patients (n=31), 6/31 (19.4 %) were males and 25/31 (80.6 %) were females; the mean duration of the disorder was 23.5 years (SD=6.69). Seventeen patients (54.8%) of those who were on MMSE scale had a score greater or equal to 24 (normal range) and the MoCA scale had a normal score (&gt;21), while 11 (35.5%) patients reported moderate to severe cognitive impairment. Analysis of the correlation coefficient between the total score of MoCA and the MMSE scale indicates a statistically significant positive correlation with Spearman rho=0.81 and P

Screening for cognitive impairment among individuals aged 60 years or over: scoping review.

Growth in aging of the population has led to increasing numbers of elderly people presenting cognitive impairment and evolution to dementia. There is still no consensus within primary care on the best strategy for screening for cognitive impairment among elderly people. Standardization of a simple but reasonably accurate instrument for a brief cognitive test, in primary care environments, would enable healthcare professionals to identify individuals who require a more in-depth assessment of cognition. To investigate the instruments used by healthcare professionals in studies conducted worldwide and ascertain the most suitable instruments for screening for cognitive impairment among individuals aged 60 years or over, in the Brazilian population. Scoping review developed at Pontifícia Universidade Católica de São Paulo, Brazil. A systematic search of the literature was conducted for primary studies using instruments to screen for cognitive impairment among individuals aged 60 years or over, in the MEDLINE, EMBASE, Cochrane Central and LILACS databases. A total of 983 articles were identified by two independent reviewers, from which 49 were selected for full-text reading, based on the criteria defined for this review. From this, 16 articles adhering to the theme of screening for cognitive impairment among the elderly were selected for in-depth analysis. The Mini-Mental State Examination was the instrument most cited in these studies. The Pfeffer Functional Activities Questionnaire and the Verbal Fluency Test (semantic category) present characteristics favoring further studies, for testing as screening instruments for cognitive impairment among elderly people in Brazil.

Screening for cognition in amyotrophic lateral sclerosis: test characteristics of a new screen

Cognitive and behavioural impairment in amyotrophic lateral sclerosis (ALS) negatively influences the quality of life and survival, and, therefore, screening for these impairments is recommended. We developed a cognitive screening tool, the amyotrophic lateral sclerosis–frontotemporal dementia–cognitive screen (ALS–FTD–Cog) and aimed to validate it in patients with ALS. During the current study, the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) was published and we, therefore, decided to compare these two cognitive screening methods. The ALS–FTD–Cog was administered to 72 patients with ALS, 21 patients with behavioural variant FTD (bvFTD) and 34 healthy controls. Twenty-nine patients with ALS underwent the ECAS. ROC curve analyses were performed and sensitivity and specificity of the ALS–FTD–Cog and ECAS were calculated, with a neuropsychological examination (NPE) as the gold standard. Cognitive impairment was present in 28% of patients with ALS. ROC curve analyses of the ALS–FTD–Cog and ECAS showed an area under the curve (AUC) of 0.72 (95% CI 0.58–0.86) and 0.95 (95% CI 0.86–1.03), respectively. Compared to a full NPE, sensitivity and specificity of the ALS–FTD–Cog were 65.0% and 63.5% and of the ECAS 83.3% and 91.3%, respectively. The sensitivity and specificity of the ALS–FTD–Cog in patients with bvFTD were 94.4% and 100%, respectively. Test characteristics of the ALS–FTD–Cog were moderate, suggesting restricted practical value, as compared to a comprehensive NPE. The ECAS had an excellent AUC and high sensitivity and specificity, indicating that it is a valid screening instrument for cognitive impairment in ALS.

Psychometric Characteristics of the Mini-Mental State Examination among Older Chinese Immigrants

Backgrounds: The recent growth of older adult immigrants and the increased burden of Alzheimer’s disease and related dementias (ADRD) call for validation of the assessment tools and timely detection of cognitive impairment. In particular, older Chinese Americans are among the fastest growing populations in the U.S., who are at high risk for delayed diagnosis and deficient management of ADRD due to limited knowledge of dementias and barriers to healthcare access. The value of the MMSE as a screening tool in detecting ADRD is well documented in western countries. Yet, little is known about the psychometric characteristics of a Chinese version of the MMSE (CMMSE) in older Chinese immigrants, whose cognitive test performances may relate to cultural and linguistic differences. Purpose: The study aims to assess factor structure and psychometric properties of CMMSE among older Chinese immigrants in the United States. Methods: Participants were recruited from the greater Chicago area in the Population-based Study of Chinese Elderly (PINE). The sample included 3,126 respondents aged 60 or over, who selected Chinese dialects in completing face-to-face interviews. A bifactor analysis was conducted to test unidimensionality of the CMMSE. Rasch modeling was used to assess scale properties. Age, sex, and education were tested for differential item functioning (DIF). Results: A bifactor analysis identified a unidimensional general factor with 30 items, reflecting a single underlying construct of cognitive capacity. We also found five concurrent subdomains with 19 items. The general factor explained 71 percent of the variance in the CMMSE. The Rasch model provided evidence of construct validity with acceptable item fit statistics. The DIF analysis showed that item biases were generally negligible. Conclusion: The CMMSE appeared to be a valid, reliable screening instrument for cognitive impairment in the US Chinese older adults. Findings provided support for the use of the CMMSE in detecting cognitive impairment among older Chinese immigrants. Although the five-factor solution has been replicated, item compositions of subdomains remain controversial. Future efforts are needed to improve neuropsychological assessment accuracy by developing a culturally and linguistically appropriate assessment tool in minority older populations.

Screening instruments for cognitive impairment in older patients in the Emergency Department: a systematic review and meta-analysis.

Backgroundcognitive impairment is highly prevalent among older patients attending the Emergency Department (ED) and is associated with adverse outcomes.Methodswe conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of cognitive screening instruments to rule out cognitive impairment in older patients in the ED. A comprehensive literature search was performed in MEDLINE, EMBASE, CINAHL and CENTRAL. A risk of bias assessment using QUADAS-2 was performed.Results23 articles, examining 18 different index tests were included. Only seven index tests could be included in the meta-analysis. For ruling out cognitive impairment irrespective of aetiology, Ottawa 3 Day Year (O3DY) (pooled sensitivity 0.90; (95% CI) 0.71–0.97) had the highest sensitivity. Fourteen articles focused on screening for cognitive impairment specifically caused by delirium. For ruling out delirium, the 4 A’s Test (4AT) showed highest sensitivity (pooled sensitivity 0.87, 95% confidence interval (95% CI) 0.74–0.94).Conclusionshigh clinical and methodological heterogeneity was found between included studies. Therefore, it is a challenge to recommend one diagnostic test for use as a screening instrument for cognitive impairment in the ED. The 4AT and O3DY seem most promising for ruling out cognitive impairment in older patients attending the ED.The review protocol was registered in PROSPERO (CRD42018082509).

Evaluation of the Ottawa 3DY as a screening tool for cognitive impairment in older emergency department patients.

This study sought to evaluate the implementation of the Ottawa 3DY Tool, a simple screening instrument for cognitive impairment, by front-line ED clinicians. We conducted a prospective cohort study in an academic ED. Patients ≥75 years underwent cognitive screening with the Ottawa 3DY by front-line nurses and physicians. Descriptive statistics were used to describe level of implementation and acceptability of the tool. Sensitivity and specificity was calculated using an Mini-Mental State Exam <25 as the cut-off for cognitive impairment. A weighted kappa was calculated to establish inter-rater agreement. Cognitive screening was completed in 260/332 eligible patients (78.3%), who were 60% female and had a mean age of 83.7 years. Facilitators to screening: perceived importance and ownership of screening and feasibility of Ottawa 3DY. Barriers to screening were: over confidence in clinical judgement and perceived lack of patient benefit. Ottawa 3DY had a sensitivity of 84.6% (64.3-95.0) and specificity of 54.2% (39.3-68.4) when completed by nurses. When completed by emergency physicians, sensitivity was 78.9% (53.9-93.0) and specificity was 70.0% (45.7-87.2). Inter-rater agreement kappa score was 0.67. This study demonstrated that incorporating the Ottawa 3DY tool into the routine evaluation of older ED patients by front-line ED clinicians is both feasible and effective. With its demonstrated good inter-rater reliability and moderate level of sensitivity and specificity when compared with the much longer MMSE, the routine adoption of this tool may help lead to improved recognition of cognitive impairment and ultimately patient and system outcomes.

C-17 10 Minutes Too Late: Using the Clock Drawing Test in the Era of DSM-5

Abstract Objective The Clock Drawing Test (CDT) is among the most researched measures of cognitive functioning and is frequently used by clinicians as a screening instrument for cognitive impairment. Nearly all the existing research on the CDT involves groups of patients diagnosed with a mild cognitive impairment (MCI) or dementia; however, recent updates to the diagnostic system (i.e., DSM-5) saw the creation of the mild and major neurocognitive disorders (NCD), designed to replace MCI and dementia diagnoses. These new diagnoses are similar to their predecessors, however, distinct differences exist that drastically alter the characteristics of these groups. Therefore, this study aimed to examine if qualitative errors on the CDT as described by Rouleau et al. (1992) are consistent with a diagnosis of mild or major NCD according to DSM-5. Method Data was retrospectively collected from a sample of patients seen at an outpatient clinic in eastern Massachusetts. CDTs from 14 healthy controls, 31 patients with mild NCD, and 18 patients with major NCD were made available for analysis. Results Contingency analysis revealed no significant differences in error frequencies when comparing mild NCD to healthy controls. Patients with major NCD committed significantly higher rates of specific stimulus bound (p = 0.021), conceptual (p = 0.026), and spatial/planning (p = 0.037) errors compared to others in the sample. Conclusions While CDT errors do not appear to distinguish mild NCD from healthy controls in our sample, our findings suggest that certain errors may serve as a warning sign to incipient major NCDs. Clinical implications and future directions are discussed.

C-34 An Investigation into the Multicultural Properties of the Clock Drawing Test: Findings from a Russian-speaking Sample

Abstract Objective The Clock Drawing Test (CDT) is a screening instrument for cognitive impairment known for its quick and easy administration style. Studies have examined if different qualitative errors on the CDT discriminate cognitive impairment from normal aging. Moreover, current research has investigated qualitative errors on the CDT in various populations (i.e. Brazil, Japan, Korea). To the best of the authors’ knowledge however, there has been no previous research on qualitative errors seen on the CDT within Russian-speaking populations. To address this gap, the present study examined qualitative errors committed on the CDT by native Russian-speakers compared to English-speaking counterparts. Method Data was retrospectively collected from a sample comprised of 13 Russian-speaking immigrants and 29 English-speakers. All participants were seen for neuropsychological testing at an outpatient clinic in eastern Massachusetts and diagnosed with major neurocognitive disorder. Results Contingency analysis revealed no significant differences in qualitative errors when comparing Russian-speakers with major neurocognitive disorder to English-speakers diagnosed with the same. Conclusions Due to similar frequencies of qualitative errors between these groups, these results suggest that the CDT may have broad utility for assessing gross cognitive functioning regardless of a patient’s native language or cultural background.

PREVALENCE OF COGNITIVE IMPAIRMENT AND ASSOCIATED FACTORS AMONG THE ELDERLY IN PHU AN COMMUNE, PHU VANG DISTRICT, THUA THIEN HUE PROVINCE IN 2016

Background: Cognitive impairment is one of the major causes of disability and dependency among the elderly. Cognitive impairment not only seriously affects the quality of the patient’s life but also has a great impact on physical, psychological and economic situation of family caregivers and society. There is little research on the prevalence of cognitive impairment and its related factors in Vietnam. Aims: The aims of this study were: (i) To examine the prevalence of cognitive impairment among the elderly in Phu An commune, Phu Vang district, Thua Thien Hue province (ii) To examine some associated factors of cognitive impairment among participants. Methods: A randomly selected sample of 343 people aged 60 years and over living in Phu An commune were interviewed and examined. MMSE test (Mini Mental State Examination) was used as a screening instrument for cognitive impairment. Multilogistic regression was undertaken for exploring associated factors of cognitive impairment. Results: The overall prevalence of cognitive impairment was 19.5%. Increasing age, inconvenient marital status (single, widowed, separate), living alone were associated with increasing risk of acquiring cognitive impairment. Conclusion: In this population, probable cognitive impairment is common. Health education program and routine health checkup for early detection and intervention of cognitive impairment are urgently needed among the elderly in Vietnam. Key words: Cognitive impairment, prevalence, associated factors, elderly people

Mini-mental state exam for children (MMC) in children with hemiplegic cerebral palsy.

ABSTRACTCognitive impairment is frequent in cerebral palsy (CP) and there is a lack of multiprofessional screening instruments.OBJECTIVE:The aim of this study was to investigate the utility of the Mini-Mental State Examination for Children (MMC), an adapted version of the Mini-Mental State Examination, in screening for cognitive impairments in children with CP.METHODS:We assessed 397 Brazilian children, 310 with typical development and 87 with CP (hemiplegic and quadriplegic forms), aged 5-16 years. Association between the MMC and general intelligence was assessed by the Colored Progressive Matrices instrument.RESULTS:Psychometric indexes for the MMC were adequate. ROC analyses revealed effective diagnostic accuracy in all ages assessed. Cut-off values are reported. Major difficulties on the MMC were observed in children with CP, particularly individuals with the quadriplegic form. Moreover, the MMC showed moderate correlation with the intelligence test, and was reliable in discriminating, among clinical cases, those with poorer cognitive abilities.CONCLUSION:The MMC could be useful as a multiprofessional screening instrument for cognitive impairment in children with hemiplegic CP. Results of the MMC in quadriplegic CP children should be interpreted with caution. Diagnosis should be confirmed by further psychological testing.

Cognitive Impairment Is Very Common in Elderly Patients With Syncope and Unexplained Falls

ObjectivesTo evaluate the prevalence of cognitive impairment (CI), including mild CI and dementia, in elderly patients with syncope and unexplained falls. In this population, we compared the use of the Mini-Mental State Examination (MMSE) with a cognitive screening test that assesses executive dysfunction typical of subcortical (vascular) CI, that is, the Montreal Cognitive Assessment (MoCA). DesignObservational cohort study. SettingOutpatient fall and syncope clinic. ParticipantsConsecutive patients aged ≥65 years with syncope and unexplained falls without loss of consciousness. MeasurementsBaseline characteristics, functional status, MMSE, MoCA, and magnetic resonance imaging scans of the brain. Main outcome: prevalence of CI, comparing the MMSE with the MoCA. CI was defined as an MMSE/MoCA score <26. Secondary outcomes: MMSE/MoCA overall and subdomain scores, Fazekas and medial temporal lobe atrophy scores. ResultsWe included 200 patients, mean age 79.5 (standard deviation 6.6) years (Syncope Group: n = 101; Fall Group: n = 99). Prevalence of CI was 16.8% (MMSE) versus 60.4% (MoCA) in the Syncope Group (P < .001) and 16.8% (MMSE) versus 56.6% (MoCA) in the Fall Group (P < .001). Prevalence of CI did not differ between the Syncope Group and Fall Group with either method. Executive dysfunction was present in both groups. ConclusionCI is as common in elderly patients with syncope as it is in patients with unexplained falls, with an overall prevalence of 58%. The MMSE fails as a screening instrument for CI in these patients, because it does not assess executive function. Therefore, we recommend the MoCA for cognitive screening in older patients with syncope and unexplained falls.

Using the cognitive assessment interview to screen cognitive impairment in psychosis.

Cognitive impairment in psychosis is closely related to functional outcome, so research into psychotic disorders is focusing most effort on treatments for improving cognition. New treatments must show not only an improvement on neuropsychological tests but also in co-primary measures of cognition. The cognitive assessment interview (CAI) is an interview-based measure of cognition which assesses the impact of cognitive deficits in patients' daily lives. Information obtained from patients and their relatives is integrated into a rater composite score. This study examines the validity of the CAI (adapted to Spanish, CAI-Sp) as a screening instrument for cognitive impairment, compared to an objective test of cognitive functioning. The psychometric properties of the CAI-Sp and its association with clinical dimensions are also explored. Eighty-one patients with a psychotic disorder and 38 healthy controls were assessed using the CAI-Sp and the screen for cognitive impairment in psychiatry (SCIP-S). Patients also underwent a clinical assessment. Poorer cognitive functioning as assessed with the CAI-Sp was associated to illness severity, specifically positive, negative and disorganised syndromes. Binary logistic regression showed that the CAI-Sp was able to detect cognitive impairment in patients, when considering CAI-Sp patient and informant information and CAI-Sp rater scores. The CAI-Sp was found to be a valid and reliable scale to assess cognitive functioning in the context of its impact on daily living. Given its ease and speed of application, the CAI-Sp could prove useful in clinical practice, though not a substitute of objective cognitive testing.

The applicability of new screening instruments for cognitive impairment in parkinson's disease in turkey

The applicability of new screening instruments for cognitive impairment in parkinson's disease in turkey

Neuropsychological Correlates of the Alzheimer's Questionnaire.

Informant-based assessments of cognition and function are commonly used to differentiate individuals with amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD) from those who are cognitively normal. However, determining the extent to which informant-based measures correlate to objective neuropsychological tests is important given the widespread use of neuropsychological tests in making clinical diagnoses of aMCI and AD. The aim of the current study is to determine how well the Alzheimer's Questionnaire (AQ) correlates with objective neuropsychological tests. The study utilized data from 300 individuals participating in a brain and body donation program. Individuals diagnosed with aMCI (n = 83) and AD (n = 67) were matched on age, gender, and education to a control individual (n = 150). The average age for the entire sample was 83.52±6.51 years with an average education level of 14.57±2.55 years. Results showed that the AQ correlated strongly with the Mini-Mental State Exam (r =-0.71, p < 0.001) and the Mattis Dementia Rating Scale-2 (r =-0.72, p < 0.001), and moderate correlations were noted for the AQ with memory function (Rey Auditory Verbal Learning Test Delayed Recall, r =-0.61, p < 0.001) and executive function (Trails B, r = 0.53, p < 0.001). The findings of this study suggest that the AQ correlates well with several neuropsychological tests and lend further support to the validity of the AQ as a screening instrument for cognitive impairment.

Screening for Cognitive Impairment in Older Adults: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for dementia. The USPSTF reviewed the evidence on the benefits, harms, and sensitivity and specificity of screening instruments for cognitive impairment in older adults and the benefits and harms of commonly used treatment and management options for older adults with mild cognitive impairment or early dementia and their caregivers. This recommendation applies to universal screening with formal screening instruments in community-dwelling adults in the general primary care population who are older than 65 years and have no signs or symptoms of cognitive impairment. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment. (I statement).

Validez de la Escala de Evaluación Cognitiva de Montreal (MoCA) para determinar deterioro cognitivo en pacientes con esquizofrenia

Introducción. La esquizofrenia es un trastorno mental que posee múltiples dimensiones sintomáticas y las alteraciones cognitivas son características cardinales en la evolución del trastorno. El uso de clinimetría para evaluar dichas deficiencias puede aportar información en la investigación en este campo. Objetivo. Determinar la validez y confiabilidad de la Escala de Evaluación Cognitiva Montreal (MoCA) para la evaluación del déficit cognitivo en pacientes con el diagnóstico de esquizofrenia. Material y métodos. Se evaluaron cien pacientes con diagnóstico de esquizofrenia reclutados en la Clínica de Esquizofrenia del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz. Se aplicaron las escalas de MoCA, MMSE y PANSS para la valoración de las funciones cognitivas. Se estableció la confiabilidad del MoCA con el Alfa de Cronbach y se estableció su validez concurrente con el MMSE y la subescala cognitiva de la PANSS. Resultados. De acuerdo al MMSE (con ajuste de escolaridad) el 8% de los pacientes fueron clasificados con deterioro cognitivo en contraste con el puntaje total del MoCA que reporto 69% de la muestra con deterioro cognitivo. La escala MoCA obtuvo una confiabilidad (Alfa de Cronbach=0.71) similar a la observada por el MMSE (?=0.70) y adecuada validez concurrente. Conclusiones. La MoCA es un instrumento confiable y válido para establecer la presencia de deterioro cognitivo leve en pacientes con esquizofrenia, sencillo y de fácil aplicación en la práctica clínica psiquiátrica cotidiana.

Mini-Mental Parkinson (MMP) as a Dementia Screening Test: Comparison with the Mini-Mental State Examination (MMSE)

As populations age, screening instruments for cognitive impairment and dementia will become of increasing importance in clinical practice. Mini-Mental Parkinson (MMP), a derivative of the Mini-Mental State Examination (MMSE), was originally described as a cognitive screening instrument for use in Parkinson's disease. Its item content addresses some of the acknowledged shortcomings of the MMSE. Pragmatic use of MMP in general cognitive clinics has not previously been examined. To compare the performance of two scales, Mini-Mental Parkinson (MMP) and the Mini-Mental State Examination (MMSE), as cognitive screening instruments for dementia in a memory clinic population. MMP was administered prospectively to 201 consecutive new patient referrals independent of other tests used to establish dementia diagnosis according to standard diagnostic criteria (DSM-IV). Diagnostic utility of MMP for dementia was measured and compared with MMSE. MMP proved easy to use and acceptable to patients. Optimal test accuracy (0.86) was at MMP cutoff of ≤ 17/32, with sensitivity 0.51, specificity 0.97, positive predictive value 0.83, negative predictive value 0.87, and area under Receiver Operating Characteristic curve 0.89. Using a higher cutoff (≤ 29/32), MMP sensitivity was 1.00 with specificity 0.70. MMP scores correlated with MMSE (r = 0.93) and diagnostic agreement was high (κ = 0.85). MMP is a useful screening instrument in the memory clinic setting, with patients who fall below the designated cutoff requiring further investigation to ascertain a cause for their cognitive impairment.

Sensitivity and specificity of Addenbrooke’s Cognitive Examination, Mattis Dementia Rating Scale, Frontal Assessment Battery and Mini Mental State Examination for diagnosing dementia in Parkinson’s disease

IntroductionAmong the non-motor features of Parkinson’s disease (PD), cognitive impairment is one of the most troublesome problems. Highly sensitive and specific screening instruments for detecting dementia in PD (PDD) are required in the clinical practice. MethodsIn our study we evaluated the sensitivity and specificity of different neuropsychological tests (Addenbrooke’s Cognitive Examination, ACE; Frontal Assessment Battery, FAB and Mattis Dementia Rating Scale, MDRS) in 73 Parkinson’s disease patients without depression. By receiver operating characteristic curve analysis, these screening instruments were tested against the recently established clinical diagnostic criteria of PDD. ResultsBest cut-off score for ACE to identify PDD was 80 points (sensitivity = 74.0%, specificity = 78.1%). For FAB the most optimal cut-off value was 12 points (sensitivity = 66.3%, specificity = 72.2%); whereas for MDRS it was 125 points (sensitivity = 89.8%, specificity = 98.3%). Among the examined test batteries, MDRS had the best clinicometric profile for detecting PDD. ConclusionAlthough the types of applied screening instruments might differ from movement disorder clinic to clinic within a country, determination of the most specific and sensitive test for the given population remains to be an important task. Our results demonstrated that the specificity and sensitivity of MDRS was better than those of ACE, FAB and MMSE in Hungary. However, further studies with larger sample size and more uniform criteria for participation are required to determine the most suitable screening instrument for cognitive impairment.