Combining functional scales and cognitive tests in screening for mild cognitive impairment at a university-based memory clinic in Brazil Combinação de escalas funcionais e testes cognitivos para rastreio de comprometimento cognitivo leve em ambulatório universitário de memória no Brasil

OBJECTIVE: To determine the diagnostic accuracy of the Mini-Mental State Examination combined to the Informant Questionnaire on Cognitive Decline in the Elderly for the identification of mild cognitive impairment. METHOD: 191 elderly subjects were assessed with the Mini-Mental State Examination, and their informants were assessed with the Informant Questionnaire on Cognitive Decline in the Elderly. Subjects were divided into three groups according to their cognitive state (controls: n = 67, mild cognitive impairment: n = 65 and dementia: n = 59), which was ascertained by clinical and neuropsychological evaluation. The diagnostic accuracy of each test in the discrimination of diagnostic groups (mild cognitive impairment vs. controls, mild cognitive impairment vs. dementia and dementia vs. controls) was examined with the aid of ROC curves. We additionally verified if the combination of both tests would increase diagnostic accuracy for mild cognitive impairment and control identification. RESULTS: The combination of the Mini-Mental State Examination and the Informant Questionnaire on Cognitive Decline in the Elderly scores did not increase the Mini-Mental State Examination diagnostic accuracy in the identification of patients with mild cognitive impairment. CONCLUSIONS: The present data do not warrant the combination of the Mini-Mental State Examination and the Informant Questionnaire on Cognitive Decline in the Elderly as a sufficient diagnostic tool in the diagnostic screening for mild cognitive impairment.<br>OBJETIVO: Avaliar a acurácia diagnóstica do Mini-Exame do Estado Mental combinado ao Questionário do Informante sobre Declínio Cognitivo na identificação de casos de comprometimento cognitivo leve. MÉTODO: 191 indivíduos idosos foram avaliados com o Mini-Exame do Estado Mental e seus informantes com o Questionário do Informante sobre Declínio Cognitivo. Os indivíduos foram divididos em três grupos de acordo com o estado cognitivo (controles: n = 67; comprometimento cognitivo leve: n = 65; demência: n = 59), segundo avaliação clínica e neuropsicológica. Pela análise de curvas ROC, avaliamos a acurácia diagnóstica de cada teste para diferenciar os grupos diagnósticos (comprometimento cognitivo leve vs. controles; comprometimento cognitivo leve vs. demência; demência vs. controles). Adicionalmente, verificamos se a combinação dos dois testes fortalece a acurácia diagnóstica para a separação dos casos de comprometimento cognitivo leve dos controles normais. RESULTADOS: A análise combinada do Questionário do Informante sobre Declínio Cognitivo e Mini-Exame do Estado Mental não aumentou a acurácia diagnóstica do Mini-Exame do Estado Mental em predizer a ocorrência de comprometimento cognitivo leve. CONCLUSÕES: Os dados deste estudo não sustentam a utilidade clínica da combinação dos escores do Mini-Exame do Estado Mental e do Questionário do Informante sobre Declínio Cognitivo no rastreio diagnóstico do comprometimento cognitivo leve

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Memory and Executive Screening (MES): a brief cognitive test for detecting mild cognitive impairment

<p>Abstract</p> <p>Background</p> <p>Mild cognitive impairment (MCI), defined as a transitional zone between normal cognition and dementia, requires a battery of formal neuropsychological tests administered by a trained rater for its diagnosis. The objective of this study was to develop a screening tool for MCI.</p> <p>Methods</p> <p>One hundred ninety seven cognitively normal controls (NC), one hundred sixteen patients with amnestic MCI –single domain (aMCI-sd), one hundred ninety five patients with amnestic MCI-multiple domain (aMCI-md), and two hundred twenty eight patients with mild Alzheimer’s disease (AD) were evaluated by comprehensive neuropsychological tests and by the Memory and Executive Screening (MES).</p> <p>Results</p> <p>Correlation analysis showed that the three indicators of the MES were significantly negatively related with age (P<0.05), yet not related with education (P>0.05). There was no ceiling or floor effect. Test completion averaged seven minutes (421.14±168.31 seconds). The receiver operating characteristics (ROC) analyses performed on the aMCI-sd group yielded 0.89 for the area under the curve (AUC) (95% CI, 0.85–0.92) for the MES-total score, with sensitivity of 0.795 and specificity of 0.828. There was 81% correct classification rate when the cut-off was set at less than 75. Meanwhile, the aMCI-md group yielded 0.95 for the AUC (95% CI, 0.93–0.97) for the MES-total score, with sensitivity of 0.87 and specificity of 0.91, and 90% correct classification rate when the cut-off was set at less than 72.</p> <p>Conclusion</p> <p>The MES, minimally time-consuming, may be a valid and easily administered cognitive screening tool with high sensitivity and specificity for aMCI, with single or multiple domain impairment.</p