Cognitive Tests to Detect Dementia: A Systematic Review and Meta-analysis

Area of Science:

• Neurology
• Gerontology
• Psychometrics

Background:

• Dementia represents a significant global public health challenge.
• The Mini-Mental State Examination (MMSE) is a widely used proprietary cognitive screening tool.
• Numerous other cognitive tests exist for dementia detection.

Purpose of the Study:

• To systematically evaluate the diagnostic accuracy of various cognitive tests for dementia detection.
• To compare the performance of different screening instruments against established dementia diagnostic criteria.

Main Methods:

• Comprehensive literature searches were conducted across MEDLINE, EMBASE, PsychoINFO, and Google Scholar up to September 2014.
• Included studies involved face-to-face cognitive testing and comparison with gold-standard dementia diagnoses.
• Bivariate random-effects models and summary receiver-operating characteristic curves were employed to assess diagnostic performance.

Main Results:

• 149 studies identified 11 distinct screening tests, encompassing over 49,000 participants.
• The Mini-Mental State Examination (MMSE) was the most frequently studied test (102 studies, 10,263 dementia patients).
• Overall sensitivity and specificity for dementia detection were 0.81 and 0.89, respectively. The Mini-Cog (0.91 sensitivity, 0.86 specificity) and ACE-R (0.92 sensitivity, 0.89 specificity) demonstrated comparable performance to the MMSE. The Montreal Cognitive Assessment showed promise for mild cognitive impairment detection (0.89 sensitivity, 0.75 specificity).

Conclusions:

• Several cognitive tests offer diagnostic performance comparable to the MMSE for dementia screening.
• The Mini-Cog and Addenbrooke's Cognitive Examination-Revised (ACE-R) are recommended as strong alternative screening tools for dementia.
• The Montreal Cognitive Assessment is a suitable alternative for identifying mild cognitive impairment.