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Introduction to Cognitive Screening Instruments: Rationale, Desiderata, and Assessment of Utility

  • Andrew J. Larner
Chapter

Abstract

Cognitive disorders are common and likely to become more so as the world population ages. Pending the definition of reliable biomarkers, the identification of such disorders, as a prelude to effective management, involves the use of cognitive screening instruments. The desiderata for effective cognitive screening instruments and the methods for assessment of their utility are considered in this chapter, prior to the in-depth analysis of specific instruments in subsequent chapters. The potential role of factors such as age, education, and culture on test performance and interpretation is also considered.

Keywords

Cognitive screening instruments Desiderata Sensitivity and specificity STARD QUADAS 

Notes

Acknowledgements

Thanks to Anne-Marie Cagliarini for a critical reading of and helpful suggestions related to this chapter.

References

  1. 1.
    Cullen B, O’Neill B, Evans JJ, Coen RF, Lawlor BA. A review of screening tests for cognitive impairment. J Neurol Neurosurg Psychiatry. 2007;78:790–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Woodford HJ, George J. Cognitive assessment in the elderly: a review of clinical methods. Q J Med. 2007;100:469–84.CrossRefGoogle Scholar
  3. 3.
    Nasreddine Z. Short clinical assessments applicable to busy practices. CNS Spectr. 2008;13(10 Suppl 16):6–9.PubMedGoogle Scholar
  4. 4.
    Ismail Z, Rajji TK, Shulman KI. Brief cognitive screening instruments: an update. Int J Geriatr Psychiatry. 2010;25:111–20.PubMedCrossRefGoogle Scholar
  5. 5.
    Burns A, Lawlor B, Craig S. Assessment scales in old age psychiatry. 2nd ed. London: Martin Dunitz; 2004.Google Scholar
  6. 6.
    Tate RL. A compendium of tests, scales, and questionnaires. The practitioner’s guide to measuring outcomes after acquired brain impairment. Hove: Psychology Press; 2010. p. 91–270.Google Scholar
  7. 7.
    Shulman KI, Feinstein A. Quick cognitive screening for clinicians. Mini mental, clock drawing, and other brief tests. London: Martin Dunitz; 2003.Google Scholar
  8. 8.
    Ferri CP, Prince M, Brayne C, et al. Global prevalence of dementia: a Delphi consensus study. Lancet. 2005;366:2112–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Alzheimer’s Society. Dementia UK. A report into the prevalence and cost of dementia prepared by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and the Institute of Psychiatry at King’s College London, for the Alzheimer’s Society. London: Alzheimer’s Society; 2007.Google Scholar
  10. 10.
    Prince M, Jackson J, editors. World Alzheimer Report 2009. London: Alzheimer’s Disease International; 2009.Google Scholar
  11. 11.
    Brayne C, Fox C, Boustani M. Dementia screening in primary care: is it time? JAMA. 2007;298:2409–11.PubMedCrossRefGoogle Scholar
  12. 12.
    Iliffe S, Robinson L, Brayne C, et al. Primary care and dementia: 1. Diagnosis, screening and disclosure. Int J Geriatr Psychiatry. 2009;24:895–901.PubMedCrossRefGoogle Scholar
  13. 13.
    National Audit Office. Improving services and support for people with dementia. London: HMSO; 2007.Google Scholar
  14. 14.
    Department of Health. Living well with dementia: a National Dementia Strategy. London: Department of Health; 2009.Google Scholar
  15. 15.
    Alzheimer’s Society. Mapping the Dementia Gap: Study produced by Tesco, Alzheimer’s Society and Alzheimer’s Scotland. London: Alzheimer’s Society; 2011.Google Scholar
  16. 16.
    Singh-Manoux A, Kivimaki M, Glymour MM, et al. Timing of onset of cognitive decline: results from Whitehall II prospective cohort study. BMJ. 2012;344:d7622.CrossRefGoogle Scholar
  17. 17.
    National Institute for Health and Clinical Excellence Assumptions used in estimating a population benchmark. National Institute for Health and Clinical Excellence. 2010. http://www.nice.org.uk/usingguidance/commissioningguides/memoryassessmentservice/assumptions.jsp. Accessed 23 Feb 2012.
  18. 18.
    Menon R, Larner AJ. Use of cognitive screening instruments in primary care: the impact of national dementia directives (NICE/SCIE, National Dementia Strategy). Fam Pract. 2011;28:272–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Larner AJ. Dementia in clinical practice: a neurological perspective. Studies in the dementia clinic. London: Springer; 2012.CrossRefGoogle Scholar
  20. 20.
    Steenland K, Macneil J, Bartell S, Lah J. Analyses of diagnostic patterns at 30 Alzheimer’s Disease Centers in the US. Neuroepidemiology. 2010;35:19–27.PubMedCrossRefGoogle Scholar
  21. 21.
    Wilson JMG, Jungner G. Principles and practice of screening for disease. Public health paper No. 34. Geneva: World Health Organisation; 1968.Google Scholar
  22. 22.
    Moorhouse P. Screening for dementia in primary care. Can Rev Alzheimers Dis Other Demen. 2009;12:8–13.Google Scholar
  23. 23.
    Wimo A, Prince M. World Alzheimer Report 2010. The global economic impact of dementia. London: Alzheimer’s Disease International; 2010.Google Scholar
  24. 24.
    Amieva H, Jacqmin-Gadda H, Orgogozo JM, et al. The 9 year cognitive decline before dementia of the Alzheimer type: a prospective population-based study. Brain. 2005;128:1093–101.PubMedCrossRefGoogle Scholar
  25. 25.
    Fox NC, Warrington EK, Freeborough PA, et al. Presymptomatic hippocampal atrophy in Alzheimer’s disease. A longitudinal MRI study. Brain. 1996;119:2001–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Fox NC, Warrington EK, Seiffer AL, Agnew SK, Rossor MN. Presymptomatic cognitive deficits in individuals at risk of familial Alzheimer’s disease: a longitudinal prospective study. Brain. 1998;121:1631–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Morris JC, Roe CM, Grant EA, et al. Pittsburgh compound B imaging and prediction of progression from cognitive normality to symptomatic Alzheimer disease. Arch Neurol. 2009;66:1469–75.PubMedCrossRefGoogle Scholar
  28. 28.
    Petersen RC, Thomas RG, Grundman M, et al. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med. 2005;352:2379–88.PubMedCrossRefGoogle Scholar
  29. 29.
    Feldman HH, Ferris S, Winblad B, et al. Effect of rivastigmine on delay to diagnosis of Alzheimer’s disease from mild cognitive impairment: the InDDEx study. Lancet Neurol. 2007;6:501–12.PubMedCrossRefGoogle Scholar
  30. 30.
    Winblad B, Gauthier S, Scinto L, et al. Safety and efficacy of galantamine in subjects with mild cognitive impairment. Neurology. 2008;70:2024–35.PubMedCrossRefGoogle Scholar
  31. 31.
    Cohen-Mansfield J. Heterogeneity in dementia: challenges and opportunities. Alzheimer Dis Assoc Disord. 2000;14:60–3.PubMedCrossRefGoogle Scholar
  32. 32.
    Mendez MF, Cummings JL. Dementia: a clinical approach. 3rd ed. Philadelphia: Butterworth-Heinemann; 2003.Google Scholar
  33. 33.
    Kurlan R, editor. Handbook of secondary dementias. New York: Taylor and Francis; 2006.Google Scholar
  34. 34.
    Larner AJ. Neuropsychological neurology: the neurocognitive impairments of neurological disorders. Cambridge: Cambridge University Press; 2008.CrossRefGoogle Scholar
  35. 35.
    Giannakopoulos P, Hof PR, editors. Dementia in clinical practice. Basel: Karger; 2009.Google Scholar
  36. 36.
    National Institute for Health and Clinical Excellence/Social Care Institute for Excellence. Dementia: supporting people with dementia and their carers in health and social care. NICE Clinical Guidance 42. London: National Institute for Health and Clinical Excellence; 2006.Google Scholar
  37. 37.
    Doran M, Larner AJ. NICE/SCIE dementia guidance: time to reconsider. Adv Clin Neurosci Rehabil. 2008;8(1):34–5.Google Scholar
  38. 38.
    Malloy PF, Cummings JL, Coffey CE, et al. Cognitive screening instruments in neuropsychiatry: a report of the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci. 1997;9:189–97.PubMedGoogle Scholar
  39. 39.
    Lorentz WJ, Scanlan JM, Borson S. Brief screening tests for dementia. Can J Psychiatry. 2002;47:723–33.PubMedGoogle Scholar
  40. 40.
    Brodaty H, Low LF, Gibson L, Burns K. What is the best dementia screening instrument for general practitioners to use? Am J Geriatr Psychiatry. 2006;14:391–400.PubMedCrossRefGoogle Scholar
  41. 41.
    Folstein MF, Folstein SE, McHugh PR. Mini-Mental State. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.PubMedCrossRefGoogle Scholar
  42. 42.
    Raiha I, Isoaho R, Ojanlatva A, Viramo P, Sulkava R, Kivela SL. Poor performance in the mini-mental state examination due to causes other than dementia. Scand J Prim Health Care. 2001;19:34–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA. 1993;269:2386–91.PubMedCrossRefGoogle Scholar
  44. 44.
    Monsch AU, Foldi NS, Ermini-Funfschilling DE, et al. Improving the diagnostic accuracy of the Mini-Mental State Examination. Acta Neurol Scand. 1995;92:145–50.PubMedCrossRefGoogle Scholar
  45. 45.
    Parker C, Philp I. Screening for cognitive impairment among older people in black and minority ethnic groups. Age Ageing. 2004;33:447–52.PubMedCrossRefGoogle Scholar
  46. 46.
    Williams CL, Tappen RM, Rosselli M, Keane F, Newlin K. Willingness to be screened and tested for cognitive impairment: cross-cultural comparison. Am J Alzheimers Dis Other Demen. 2010;25:160–6.PubMedCrossRefGoogle Scholar
  47. 47.
    Borson S, Scanlan J, Brush M, Vitiliano P, Dokmak A. The mini-cog: a cognitive “vital signs” measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000;15:1021–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Inouye SK, Robison JT, Froehlich TE, Richardson ED. The time and change test: a simple screening test for dementia. J Gerontol A Biol Sci Med Sci. 1998;53:M281–6.PubMedCrossRefGoogle Scholar
  49. 49.
    Mitrushina M, Boone KB, Razani J, D’Elia LF. Handbook of normative data for neuropsychological assessment. 2nd ed. Oxford: Oxford University Press; 2005.Google Scholar
  50. 50.
    Strauss E, Sherman EMS, Spreen O. A compendium of neuropsychological tests: administration, norms, and commentary. 3rd ed. New York: Oxford University Press; 2006.Google Scholar
  51. 51.
    Lezak MD, Howieson DB, Bigler ED, Tranel D. Neuropsychological assessment. 5th ed. New York: Oxford University Press; 2012.Google Scholar
  52. 52.
    Mitchell AJ, Malladi S. Screening and case-finding tools for the detection of dementia. Part I: evidence-based meta-analysis of multidomain tests. Am J Geriatr Psychiatry. 2010;18:759–82.PubMedCrossRefGoogle Scholar
  53. 53.
    Altman DG, Machin D, Bryant TN, Gardner MJ, editors. Statistics with confidence. Confidence intervals and statistical guidelines. 2nd ed. London: BMJ Books; 2000. p. 105–19.Google Scholar
  54. 54.
    Qizilbash N. Evidence-based diagnosis. In: Qizilbash N, Schneider LS, Chui H, et al., editors. Evidence-based dementia practice. Oxford: Blackwell; 2002. p. 18–25.Google Scholar
  55. 55.
    Cook C, Cleland J, Huijbregts P. Creation and critique of studies of diagnostic accuracy: use of the STARD and QUADAS methodological quality assessment tools. J Man Manipulative Ther. 2007;15:93–102.CrossRefGoogle Scholar
  56. 56.
    Nordenstrom J. Evidence-based medicine in Sherlock Holmes’ footsteps. Oxford: Blackwell; 2007. p. 51–60.CrossRefGoogle Scholar
  57. 57.
    Stein J, Luppa M, Brahler E, Konig HH, Riedel-Heller SG. The assessment of changes in cognitive functioning: reliable change indices for neuropsychological instruments in the elderly – a systematic review. Dement Geriatr Cogn Disord. 2010;29:275–86.PubMedCrossRefGoogle Scholar
  58. 58.
    Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.CrossRefGoogle Scholar
  59. 59.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.PubMedCrossRefGoogle Scholar
  60. 60.
    Oliveira MRF, AdeC G, Toscano CM. QUADAS and STARD: evaluating the quality of diagnostic accuracy studies. Rev Saude Publica. 2011;45:416–22.PubMedCrossRefGoogle Scholar
  61. 61.
    Scottish Intercollegiate Guidelines Network. Methodology checklist 5: studies of diagnostic accuracy. In: A guideline developer’s handbook. Edinburgh: SIGN; 2007, Annex B.Google Scholar
  62. 62.
    Bossuyt PM, Reitsma JB, Bruns DE, et al. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. BMJ. 2003;326:41–4.PubMedCrossRefGoogle Scholar
  63. 63.
    Bossuyt PM, Reitsma JB, Bruns DE, et al. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Clin Chem. 2003;49:7–18.PubMedCrossRefGoogle Scholar
  64. 64.
    Bachmann LM, Puhan MA, ter Riet G, Bossuyt PM. Sample sizes of studies on diagnostic accuracy: literature survey. BMJ. 2006;332:1127–9.PubMedCrossRefGoogle Scholar
  65. 65.
    Ferrante di Ruffano L, Hyde CJ, McCaffery KJ, Bossuyt PM, Deeks JJ. Assessing the value of diagnostic tests: a framework for designing and evaluating trials. BMJ. 2012;344:e686.PubMedCrossRefGoogle Scholar
  66. 66.
    Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 2003;3:25.PubMedCrossRefGoogle Scholar
  67. 67.
    Whiting P, Rutjes AW, Dinnes J, Reitsma J, Bossuyt PM, Kleijnen J. Development and validation of methods for assessing the quality of diagnostic accuracy studies. Health Technol Assess. 2004;8:iii, 1–234.PubMedGoogle Scholar
  68. 68.
    Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155:529–36.PubMedGoogle Scholar
  69. 69.
    Crawford S, Whitnall L, Robertson J, Evans JJ. A systematic review of the accuracy and ­clinical utility of the Addenbrooke’s Cognitive Examination and the Addenbrooke’s Cognitive Examination-Revised in the diagnosis of dementia. Int J Geriatr Psychiatry. 2012;27:659–69.Google Scholar
  70. 70.
    Marson A, Jacoby A, Johnson A, et al. Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures: a randomised controlled trial. Lancet. 2005;365:2007–12.PubMedCrossRefGoogle Scholar
  71. 71.
    Dubois B, Feldman HH, Jacova C, et al. Research criteria for the diagnosis of Alzheimer’s disease: revising the NINCDS-ADRDA criteria. Lancet Neurol. 2007;6:734–46.PubMedCrossRefGoogle Scholar
  72. 72.
    Albert MS, DeKosky ST, Dickson D, et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7:270–9.PubMedCrossRefGoogle Scholar
  73. 73.
    Sperling RA, Aisen PS, Beckett LA, et al. Toward defining the preclinical stages of Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7:280–92.PubMedCrossRefGoogle Scholar
  74. 74.
    Galvin JE, Fagan AM, Holtzman DM, Mintun MA, Morris JC. Relationship of dementia screening tests with biomarkers of Alzheimer’s disease. Brain. 2010;133:3290–300.PubMedCrossRefGoogle Scholar
  75. 75.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edn, text revision (DSM-IV-TR). Washington: American Psychiatric Association; 2000.Google Scholar
  76. 76.
    Landau SM, Harvey D, Madison CM, et al. Comparing predictors of conversion and decline in mild cognitive impairment. Neurology. 2010;75:230–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Cognitive Function Clinic, Walton Centre for Neurology and NeurosurgeryLiverpoolUK

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