Rosalind Lees1, Johann Selvarajah1, Candida Fenton1, Sarah T Pendlebury1, Peter Langhorne1, David J Stott1, Terence J Quinn1. 1. From the Institute of Cardiovascular and Medical Sciences (R.L., P.L., D.J.S., T.J.Q.), Institute of Neuroscience and Psychology (J.S.), MRC/CSO Social and Public Health Sciences Unit (C.F.), University of Glasgow, UK; and NIHR Biomedical Research Centre and Stroke Prevention Research Unit, John Radcliffe Hospital, Oxford, UK (S.T.P.).
Abstract
BACKGROUND AND PURPOSE: Guidelines recommend screening stroke-survivors for cognitive impairments. We sought to collate published data on test accuracy of cognitive screening tools. METHODS: Index test was any direct, cognitive screening assessment compared against reference standard diagnosis of (undifferentiated) multidomain cognitive impairment/dementia. We used a sensitive search statement to search multiple, cross-disciplinary databases from inception to January 2014. Titles, abstracts, and articles were screened by independent researchers. We described risk of bias using Quality Assessment of Diagnostic Accuracy Studies tool and reporting quality using Standards for Reporting of Diagnostic Accuracy guidance. Where data allowed, we pooled test accuracy using bivariate methods. RESULTS: From 19 182 titles, we reviewed 241 articles, 35 suitable for inclusion. There was substantial heterogeneity: 25 differing screening tests; differing stroke settings (acute stroke, n=11 articles), and reference standards used (neuropsychological battery, n=21 articles). One article was graded low risk of bias; common issues were case-control methodology (n=7 articles) and missing data (n=22). We pooled data for 4 tests at various screen positive thresholds: Addenbrooke's Cognitive Examination-Revised (<88/100): sensitivity 0.96, specificity 0.70 (2 studies); Mini Mental State Examination (<27/30): sensitivity 0.71, specificity 0.85 (12 studies); Montreal Cognitive Assessment (<26/30): sensitivity 0.95, specificity 0.45 (4 studies); MoCA (<22/30): sensitivity 0.84, specificity 0.78 (6 studies); Rotterdam-CAMCOG (<33/49): sensitivity 0.57, specificity 0.92 (2 studies). CONCLUSIONS: Commonly used cognitive screening tools have similar accuracy for detection of dementia/multidomain impairment with no clearly superior test and no evidence that screening tools with longer administration times perform better. MoCA at usual threshold offers short assessment time with high sensitivity but at cost of specificity; adapted cutoffs have improved specificity without sacrificing sensitivity. Our results must be interpreted in the context of modest study numbers: heterogeneity and potential bias.
BACKGROUND AND PURPOSE: Guidelines recommend screening stroke-survivors for cognitive impairments. We sought to collate published data on test accuracy of cognitive screening tools. METHODS: Index test was any direct, cognitive screening assessment compared against reference standard diagnosis of (undifferentiated) multidomain cognitive impairment/dementia. We used a sensitive search statement to search multiple, cross-disciplinary databases from inception to January 2014. Titles, abstracts, and articles were screened by independent researchers. We described risk of bias using Quality Assessment of Diagnostic Accuracy Studies tool and reporting quality using Standards for Reporting of Diagnostic Accuracy guidance. Where data allowed, we pooled test accuracy using bivariate methods. RESULTS: From 19 182 titles, we reviewed 241 articles, 35 suitable for inclusion. There was substantial heterogeneity: 25 differing screening tests; differing stroke settings (acute stroke, n=11 articles), and reference standards used (neuropsychological battery, n=21 articles). One article was graded low risk of bias; common issues were case-control methodology (n=7 articles) and missing data (n=22). We pooled data for 4 tests at various screen positive thresholds: Addenbrooke's Cognitive Examination-Revised (<88/100): sensitivity 0.96, specificity 0.70 (2 studies); Mini Mental State Examination (<27/30): sensitivity 0.71, specificity 0.85 (12 studies); Montreal Cognitive Assessment (<26/30): sensitivity 0.95, specificity 0.45 (4 studies); MoCA (<22/30): sensitivity 0.84, specificity 0.78 (6 studies); Rotterdam-CAMCOG (<33/49): sensitivity 0.57, specificity 0.92 (2 studies). CONCLUSIONS: Commonly used cognitive screening tools have similar accuracy for detection of dementia/multidomain impairment with no clearly superior test and no evidence that screening tools with longer administration times perform better. MoCA at usual threshold offers short assessment time with high sensitivity but at cost of specificity; adapted cutoffs have improved specificity without sacrificing sensitivity. Our results must be interpreted in the context of modest study numbers: heterogeneity and potential bias.
Authors: Eric D Hamlett; Edward J Goetzl; Aurélie Ledreux; Vitaly Vasilevko; Heather A Boger; Angela LaRosa; David Clark; Steven L Carroll; María Carmona-Iragui; Juan Fortea; Elliott J Mufson; Marwan Sabbagh; Abdul H Mohammed; Dean Hartley; Eric Doran; Ira T Lott; Ann-Charlotte Granholm Journal: Alzheimers Dement Date: 2016-10-15 Impact factor: 21.566
Authors: Grégory Kuchcinski; Fanny Munsch; Renaud Lopes; Antoine Bigourdan; Jason Su; Sharmila Sagnier; Pauline Renou; Jean-Pierre Pruvo; Brian K Rutt; Vincent Dousset; Igor Sibon; Thomas Tourdias Journal: Brain Date: 2017-07-01 Impact factor: 13.501
Authors: Benjamin Hotter; Inken Padberg; Andrea Liebenau; Petra Knispel; Sabine Heel; Diethard Steube; Jörg Wissel; Ian Wellwood; Andreas Meisel Journal: Eur Stroke J Date: 2018-04-19
Authors: Sarah T Pendlebury; Stephen P Klaus; Ross J Thomson; Ziyah Mehta; Rose M Wharton; Peter M Rothwell Journal: Stroke Date: 2015-10-13 Impact factor: 7.914
Authors: Sarah T Pendlebury; Ping-Jen Chen; Linda Bull; Louise Silver; Ziyah Mehta; Peter M Rothwell Journal: Stroke Date: 2015-02-05 Impact factor: 7.914
Authors: Shadi Yaghi; George Cotsonis; Adam de Havenon; Shyam Prahbakaran; Jose G Romano; Ronald M Lazar; Randolph S Marshall; Edward Feldmann; David S Liebeskind Journal: J Stroke Cerebrovasc Dis Date: 2020-02-07 Impact factor: 2.136
Authors: Sarah T Pendlebury; Ping-Jen Chen; Sarah J V Welch; Fiona C Cuthbertson; Rose M Wharton; Ziyah Mehta; Peter M Rothwell Journal: Stroke Date: 2015-05-07 Impact factor: 7.914