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Brief Cognitive Tests Used in Primary Care Cannot Accurately Differentiate Mild Cognitive Impairment from Subjective Cognitive Decline
Lund University, Sweden.
Lund University, Sweden.
Lund University, Sweden.
Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Lund University, Sweden.ORCID iD: 0000-0002-3785-5630
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2020 (English)In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 75, no 4, p. 1191-1201Article in journal (Refereed) Published
Abstract [en]

Background: Differentiating mild cognitive impairment (MCI) from subjective cognitive decline (SCD) is important because of the higher progression rate to dementia for MCI and when considering future disease-modifying drugs that will have treatment indications at the MCI stage. Objective: We examined if the two most widely-used cognitive tests, the Mini-Mental State Examination (MMSE) and clock-drawing test (CDT), and a test of attention/executive function (AQT) accurately can differentiate MCI from SCD. Methods: We included 466 consecutively recruited non-demented patients with cognitive complaints from the BioFINDER study who had been referred to memory clinics, predominantly from primary care. They were classified as MCI (n = 258) or SCD (n = 208) after thorough neuropsychological assessments. The accuracy of MMSE, CDT, and AQT for identifying MCI was examined both in training and validation samples and in the whole population. Results: As a single test, MMSE had the highest accuracy (sensitivity 73%, specificity 60%). The best combination of two tests was MMSE < 27 points or AQT > 91 seconds (sensitivity 56%, specificity 78%), but in logistic regression models, their AUC (0.76) was not significantly better than MMSE alone (AUC 0.75). CDT and AQT performed significantly worse (AUC 0.71; p < 0.001-0.05); otherwise no differences were seen between any combination of two or three tests. Conclusion: Neither single nor combinations of tests could differentiate MCI from SCD with adequately high accuracy. There is a great need to further develop, validate, and implement accurate screening-tests for primary care to improve accurate identification of MCI among individuals that seek medical care due to cognitive symptoms.

Place, publisher, year, edition, pages
IOS Press, 2020. Vol. 75, no 4, p. 1191-1201
Keywords [en]
AQT, clock drawing test, cognitive screening, diagnostic accuracy, mild cognitive impairment, Mini-Mental State Examination, subjective cognitive decline
National Category
Gerontology, specialising in Medical and Health Sciences
Research subject
Medicine, Gerontology
Identifiers
URN: urn:nbn:se:lnu:diva-97731DOI: 10.3233/JAD-191191ISI: 000550022100011PubMedID: 32417771Scopus ID: 2-s2.0-85090484358OAI: oai:DiVA.org:lnu-97731DiVA, id: diva2:1461362
Available from: 2020-08-26 Created: 2020-08-26 Last updated: 2022-12-08Bibliographically approved

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Thulesius, Hans

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