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A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment
Published on: January 11, 2020
Screening for mild cognitive impairment in elderly ambulatory patients with cognitive complaints
Giovanni Ravaglia1, Paola Forti, Fabiola Maioli
1Department of Internal Medicine, Cardioangiology and Hepatology, University Hospital S. Orsola-Malpighi, Bologna, Italy. ravaglia@med.unibo.it
Background And Aims:
Identification of patients with Mild Cognitive Impairment (MCI) is strongly recommended because of their increased risk of dementia. Two brief global cognitive instruments, the Mini Mental State Examination (MMSE) and the Clock Drawing Test (CDT), were examined as useful screening methods for MCI.
Methods:
The sensitivity and specificity of MMSE and CDT, scored using the Sunderland and Wolf-Klein methods, were evaluated in 113 elderly individuals with three different MCI subtypes: amnestic, multiple domain impairments, and single non-memory domain. Diagnoses were made on the basis of extensive clinical and neuropsychometric assessment.
Results:
Used alone, MMSE and CDT at standard cut-offs were highly specific (about 0.80) but rather insensitive (less than 0.50) to all MCI subtypes. By contrast, when used in combination, an abnormal result on either MMSE or CDT scored by the Sunderland method had a specificity of 0.69 [0.57-0.81] and a sensitivity of 0.75 [0.64-0.87] for multiple domain impairments MCI. Results were similar for MMSE in combination with CDT scored by the Wolf-Klein method (specificity 0.71 [0.59-0.83]; sensitivity 0.68 [0.56-0.80]).
Conclusions:
MMSE and CDT alone are not valid screening methods for MCI detection. In combination, they reach fair sensitivity and specificity for the multiple domain impairment MCI subtype. However, some theoretical concerns relating to this subtype, together with the uncertainty that still lingers about its prognostic value, caution against routine use of MMSE and CDT as MCI screening instruments.
Insights
The Mini Mental State Examination (MMSE) and Clock Drawing Test (CDT) are not effective alone for screening Mild Cognitive Impairment (MCI). Combined, they show fair accuracy for the multiple domain impairment MCI subtype, but routine use is cautioned.
Area of Science:
- Gerontology
- Neurology
- Cognitive Science
Background:
- Early identification of Mild Cognitive Impairment (MCI) is crucial due to the elevated risk of dementia.
- Brief cognitive screening tools are needed for efficient patient assessment.
Purpose of the Study:
- To evaluate the Mini Mental State Examination (MMSE) and Clock Drawing Test (CDT) as screening methods for MCI.
- To assess the diagnostic accuracy of MMSE and CDT, individually and in combination, for different MCI subtypes.
Main Methods:
- Evaluated MMSE and CDT sensitivity and specificity in 113 elderly individuals with diagnosed MCI subtypes.
- Utilized Sunderland and Wolf-Klein scoring methods for the CDT.
- Diagnoses were confirmed through comprehensive clinical and neuropsychometric evaluations.
Main Results:
- MMSE and CDT alone demonstrated high specificity but low sensitivity for all MCI subtypes.
- The combination of MMSE and CDT (Sunderland method) achieved 75% sensitivity and 69% specificity for multiple domain impairments MCI.
- Similar results were observed with the Wolf-Klein scoring method.
Conclusions:
- MMSE and CDT as standalone instruments are not sufficiently valid for MCI screening.
- Combined use offers moderate accuracy for the multiple domain impairment MCI subtype.
- Concerns regarding this subtype and prognostic uncertainty advise against routine implementation of these combined screening tools.
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