Three screening methods for cognitive dysfunction using the Mini-Mental State Examination and Korean Dementia...

Area of Science:

• Neurology
• Geriatrics
• Psychometrics

Background:

• Cognitive dysfunction screening is crucial for early diagnosis and management.
• Traditional cognitive tests and informant reports may not always be accessible in clinical settings.
• Investigating alternative screening methods is essential for broader application.

Purpose of the Study:

• To evaluate and compare three distinct screening methods for cognitive dysfunction.
• To assess the efficacy of the Mini-Mental State Examination (MMSE) alone, a combined MMSE and Korean dementia screening questionnaire (KDSQ) approach, and a decision tree model.
• To determine the optimal screening strategy based on diagnostic accuracy and sensitivity.

Main Methods:

• A cohort of 2861 dementia patients, 3519 mild cognitive impairment patients, and 1375 controls were recruited.
• Three screening methods were tested: MMSE alone, MMSE+KDSQ (conventional cut-off), and MMSE+KDSQ (decision tree).
• Diagnostic performance was evaluated using receiver operating characteristic curves and classification accuracy.

Main Results:

• The MMSE+KDSQ (cut-off) method demonstrated the highest accuracy in discriminating dementia from controls (AUC 0.899) and any cognitive dysfunction from controls (AUC 0.784).
• The MMSE alone method showed the highest accuracy for discriminating mild cognitive impairment from controls (AUC 0.683).
• The MMSE+KDSQ (decision tree) method achieved the highest overall classification accuracy (70.0%) and sensitivity across all discriminations.

Conclusions:

• The three evaluated screening methods possess distinct strengths for identifying and staging cognitive dysfunction.
• The choice of screening method can be tailored to specific clinical settings and situational requirements.
• The MMSE+KDSQ decision tree approach offers a highly sensitive and accurate option for cognitive screening.