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A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment
Published on: January 11, 2020
Diagnosing Mild Cognitive Impairment (MCI) in clinical trials: a systematic review
Blossom Christa Maree Stephan1, Thais Minett, Emma Pagett
1Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
Objective:
To describe how criteria for amnestic Mild Cognitive Impairment (aMCI) have been operationalised in randomised controlled clinical trials (RCTs).
Design:
Systematic review.
Information Sources:
EMBASE, PubMed and PSYCHInfo were searched from their inception to February 2012. Electronic clinical trial registries were also searched (February 2012).
Study Selection:
RCTs were included where participant selection was made using Petersen et al-defined aMCI. There was no restriction on intervention type or the outcome tested.
Data Extraction:
For each trial, we extracted information on study design, demographics, exclusion criteria and the operationalisation strategy for the five aMCI diagnostic criteria including: (1) memory complaint, (2) normal general cognitive function, (3) memory impairment, (4) no functional impairment and (5) no dementia.
Results:
223 articles and 278 registered trials were reviewed, of which 22 met inclusion criteria. Various methods were applied for operationalising aMCI criteria resulting in variability in participant selection. Memory complaint and assessment of general cognitive function were the most consistently measured criteria. There was large heterogeneity in the neuropsychological methods used to determine memory impairment. It was not possible to assess the impact of these differences on case selection accuracy for dementia prediction. Further limitations include selective and unclear reporting of how each of the criteria was measured.
Conclusions:
The results highlight the urgent need for a standardised approach to map aMCI. Lack of uniformity in clinical diagnosis, however, is not exclusively a problem for MCI but also for other clinical states such as dementia including Alzheimer's disease, Lewy Body, frontotemporal or vascular dementia. Defining a uniform approach to MCI classification, or indeed for any classification concept within the field of dementia, should be a priority if further trials are to be undertaken in the older aged population based on these concepts.
Insights
Standardizing amnestic Mild Cognitive Impairment (aMCI) criteria in clinical trials is crucial due to varied operationalization methods. This variability impacts participant selection and dementia prediction accuracy, necessitating a uniform diagnostic approach.
Area of Science:
- Neurology
- Clinical Trials
- Cognitive Science
Background:
- Mild Cognitive Impairment (MCI) is a transitional stage between normal aging and dementia.
- Amnestic MCI (aMCI) specifically affects memory and is a risk factor for Alzheimer's disease.
- Standardized diagnostic criteria are essential for consistent research and clinical practice.
Purpose of the Study:
- To systematically review and describe the operationalization of amnestic Mild Cognitive Impairment (aMCI) criteria in randomized controlled trials (RCTs).
- To identify variations in how aMCI diagnostic criteria are applied in clinical research.
- To highlight the need for standardization in aMCI assessment for future dementia research.
Main Methods:
- A systematic review of EMBASE, PubMed, and PSYCHInfo databases, along with clinical trial registries, was conducted up to February 2012.
- Included RCTs utilized Petersen et al.'s definition of aMCI for participant selection.
- Data extracted included study design, demographics, exclusion criteria, and the specific methods used to operationalize the five aMCI criteria.
Main Results:
- Twenty-two randomized controlled trials met the inclusion criteria.
- Significant variability was observed in the operationalization of aMCI criteria, affecting participant selection.
- While memory complaint and general cognitive function were consistently measured, neuropsychological methods for assessing memory impairment showed high heterogeneity.
- The impact of these variations on dementia prediction accuracy could not be assessed due to reporting limitations.
Conclusions:
- There is an urgent need for a standardized approach to defining and operationalizing aMCI criteria.
- Lack of uniformity in diagnosing MCI and other dementia subtypes (e.g., Alzheimer's, Lewy Body dementia) hinders research progress.
- Establishing a uniform classification system for MCI and other dementia concepts is a priority for future research in aging populations.
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