Diagnostic Accuracy, Effectiveness and Cost for Cognitive Impairment and Dementia Screening of Three Short Cognitive Tests Applicable to Illiterates

BACKGROUND: Illiteracy, a universal problem, limits the utilization of the most widely used short cognitive tests. Our objective was to assess and compare the effectiveness and cost for cognitive impairment (CI) and dementia (DEM) screening of three short cognitive tests applicable to illiterates. METHODS: Phase III diagnostic test evaluation study was performed during one year in four Primary Care centers, prospectively including individuals with suspicion of CI or DEM. All underwent the Eurotest, Memory Alteration Test (M@T), and Phototest, applied in a balanced manner. Clinical, functional, and cognitive studies were independently performed in a blinded fashion in a Cognitive Behavioral Neurology Unit, and the gold standard diagnosis was established by consensus of expert neurologists on the basis of these results. Effectiveness of tests was assessed as the proportion of correct diagnoses (diagnostic accuracy [DA]) and the kappa index of concordance (k) with respect to gold standard diagnoses. Costs were based on public prices at the time and hospital accounts. RESULTS: The study included 139 individuals: 47 with DEM, 36 with CI, and 56 without CI. No significant differences in effectiveness were found among the tests. For DEM screening: Eurotest (k = 0.71 [0.59-0.83], DA = 0.87 [0.80-0.92]), M@T (k = 0.72 [0.60-0.84], DA = 0.87 [0.80-0.92]), Phototest (k = 0.70 [0.57-0.82], DA = 0.86 [0.79-0.91]). For CI screening: Eurotest (k = 0.67 [0.55-0.79]; DA = 0.83 [0.76-0.89]), M@T (k = 0.52 [0.37-0.67]; DA = 0.80 [0.72-0.86]), Phototest (k = 0.59 [0.46-0.72]; DA = 0.79 [0.71-0.86]). There were no differences in the cost of DEM screening, but the cost of CI screening was significantly higher with M@T (330.7 ± 177.1 €, mean ± sd) than with Eurotest (294.1 ± 195.0 €) or Phototest (296.0 ± 196. 5 €). Application time was shorter with Phototest (2.8 ± 0.8 min) than with Eurotest (7.1 ± 1.8 min) or M@T (6.8 ± 2.2 min). CONCLUSIONS: Eurotest, M@T, and Phototest are equally effective. Eurotest and Phototest are both less expensive options but Phototest is the most efficient, requiring the shortest application time

Impact of amyloid-PET in daily clinical management of patients with cognitive impairment fulfilling appropriate use criteria

To evaluate the use of amyloid-positron emission tomography (PET) in routine clinical practice, in a selected population with cognitive impairment that meets appropriate use criteria (AUC). A multicenter, observational, prospective case-series study of 211patients from 2 level-3 hospitals who fulfilled clinical AUC for amyloid-PET scan in a naturalistic setting. Certainty degree was evaluated using a 5-point Likert scale: 0 (very low probability); 1 (low probability); 2 (intermediate probability); 3 (high probability); and 4 (practically sure), before and after amyloid PET. The treatment plan was considered as cognition-specific or noncognition-specific. Amyloid-PET was positive in 118 patients (55.9%) and negative in 93 patients (44.1%). Diagnostic prescan confidence according amyloid-PET results showed that in both, negative and positive-PET subgroup, the most frequent category was intermediate probability (45.7% and 55.1%, respectively). After the amyloid-PET, the diagnostic confidence showed a very different distribution, that was, in the negative-PET group the most frequent categories are very unlikely (70.7%) and unlikely (29.3%), while in the positive- PET group were very probable (57.6%) and practically sure (39%). Only in 14/211 patients (6.6%) the result of the amyloid-PET did not influence the diagnostic confidence, while in 194 patients (93.4%), the diagnostic confidence improved significantly after amyloid- PET results. The therapeutic intention was modified in 93 patients (44.1%). Specific treatment for Alzheimer disease was started, before amyloid-PET, in 80 patients (37.9%). This naturalistic study provides evidence that the implementation of amyloid-PET is associated with a significant improvement in diagnostic confidence and has a high impact on the therapeutic management of patients with mild cognitive impairment fulfilled clinical AUC

Using XAI in the Clock Drawing Test to reveal the cognitive impairment pattern.

he prevalence of dementia is currently increasing worldwide. This syndrome produces a deteriorationin cognitive function that cannot be reverted. However, an early diagnosis can be crucial for slowing itsprogress. The Clock Drawing Test (CDT) is a widely used paper-and-pencil test for cognitive assessmentin which an individual has to manually draw a clock on a paper. There are a lot of scoring systems forthis test and most of them depend on the subjective assessment of the expert. This study proposes acomputer-aided diagnosis (CAD) system based on artificial intelligence (AI) methods to analyze the CDTand obtain an automatic diagnosis of cognitive impairment (CI). This system employs a preprocessingpipeline in which the clock is detected, centered and binarized to decrease the computational burden.Then, the resulting image is fed into a Convolutional Neural Network (CNN) to identify the informativepatterns within the CDT drawings that are relevant for the assessment of the patient’s cognitive status.Performance is evaluated in a real context where patients with CI and controls have been classified byclinical experts in a balanced sample size of 3282 drawings. The proposed method provides an accuracyof 75.65% in the binary case-control classification task, with an AUC of 0.83. These results are indeedrelevant considering the use of the classic version of the CDT. The large size of the sample suggests thatthe method proposed has a high reliability to be used in clinical contexts and demonstrates the suitabilityof CAD systems in the CDT assessment process. Explainable artificial intelligence (XAI) methods areapplied to identify the most relevant regions during classification. Finding these patterns is extremelyhelpful to understand the brain damage caused by CI. A validation method using resubstitution withupper bound correction in a machine learning approach is also discusseThis work was supported by the MCIN/ AEI/10.13039/501100011033/ and FEDER “Una manera de hacer Europa” under the RTI2018- 098913-B100 project, by the Consejeria de Economia, Innovacion, Ciencia y Empleo (Junta de An765 dalucia) and FEDER under CV20-45250, A-TIC080-UGR18, B-TIC-586-UGR20 and P20-00525 projects, and by the Ministerio de Universidades under the FPU18/04902 grant given to C. JimenezMesa and the Margarita-Salas grant to J.E. Arco

Practical application of brief cognitive tests

RESUMEN Introducción.- Los test cognitivos breves (TCB) pueden ayudar a detectar el deterioro cognitivo (DC) en el ámbito asistencial. Se han desarrollado y/o validado varios TCB en nuestro país, pero no existen recomendaciones específicas para su uso. Desarrollo.- Revisión de estudios de rendimiento diagnóstico llevados a cabo en España con TCB que requieran menos de 20 minutos. Recomendaciones de uso consensuadas por expertos sobre la base de las características de los TCB y de los estudios disponibles. Conclusión.- El Fototest, el Memory Impairment Screen (MIS) y el Mini-Mental State Examination (MMSE) son las opciones más recomendables para el primer nivel asistencial, pudiendo añadirse otros test (Test del Reloj [TR], test de fluidez verbal [TFV]) en caso de resultado negativo y queja o sospecha persistente (aproximación escalonada). En el segundo nivel asistencial es conveniente una evaluación sistemática de las distintas áreas cognitivas, que puede llevarse a cabo con instrumentos como el Montreal Cognitive Assessment, MMSE, Rowland Universal Dementia Assessment o Addenbrooke's Cognitive Examination, o bien mediante el uso escalonado o combinado de herramientas más simples (TR, TFV, Fototest, MIS, Test de Alteración de la Memoria, Eurotest). El uso asociado de cuestionarios cumplimentados por un informador (CCI) aporta valor añadido a los TCB en la detección del DC. La elección de los instrumentos vendrá condicionada por las características del paciente, la experiencia del clínico y el tiempo disponible. Los TCB y CCI deben reforzar -pero nunca suplantar- el juicio clínico, la comunicación con el paciente y el diálogo interprofesional

Aplicación práctica de los test cognitivos breves

Introducción.- Los test cognitivos breves (TCB) pueden ayudar a detectar el deterioro cognitivo (DC) en el ámbito asistencial. Se han desarrollado y/o validado varios TCB en nuestro país, pero no existen recomendaciones específicas para su uso. Desarrollo.- Revisión de estudios de rendimiento diagnóstico llevados a cabo en España con TCB que requieran menos de 20 minutos. Recomendaciones de uso consensuadas por expertos sobre la base de las características de los TCB y de los estudios disponibles. Conclusión.- El Fototest, el Memory Impairment Screen (MIS) y el Mini-Mental State Examination (MMSE) son las opciones más recomendables para el primer nivel asistencial, pudiendo añadirse otros test (Test del Reloj [TR], test de fluidez verbal [TFV]) en caso de resultado negativo y queja o sospecha persistente (aproximación escalonada). En el segundo nivel asistencial es conveniente una evaluación sistemática de las distintas áreas cognitivas, que puede llevarse a cabo con instrumentos como el Montreal Cognitive Assessment, MMSE, Rowland Universal Dementia Assessment o Addenbrooke's Cognitive Examination, o bien mediante el uso escalonado o combinado de herramientas más simples (TR, TFV, Fototest, MIS, Test de Alteración de la Memoria, Eurotest). El uso asociado de cuestionarios cumplimentados por un informador (CCI) aporta valor añadido a los TCB en la detección del DC. La elección de los instrumentos vendrá condicionada por las características del paciente, la experiencia del clínico y el tiempo disponible. Los TCB y CCI deben reforzar -pero nunca suplantar- el juicio clínico, la comunicación con el paciente y el diálogo interprofesional

El EUROTEST: test europeo de detección de deterioro cognitivo

Tesis Univ. Granada. Departamento de Medicina Legal, Toxicología y Psiquiatría. Leída el 23 de mayo de 200

A systematic review and meta-analysis of the diagnostic accuracy of the Phototest for cognitive impairment and dementia

Abstract The recently developed Phototest is a simple, easy and very brief test for detecting cognitive impairment or dementia. Objective: To evaluate the diagnostic accuracy of the Phototest for detecting cognitive impairment or dementia. Methods: We used a manually created database to search for studies evaluating the Phototest diagnostic yield and performed an initial meta-analysis to determine sensitivity (Sn) and specificity (Sp) of diagnostic parameters. We also performed a second meta-analysis of individual participant data. Results: In total, 6 studies were included in the meta-analysis. For dementia, Sn was 0.85 (95% CI, 0.82-0.88) and Sp 0.87 (95% CI, 0.85-0.99); for cognitive impairment, Sn was 0.80 (95% CI, 0.77-0.92) and Sp 0.88 (95% CI, 0.86-0.90). In the individual data meta-analysis, 1565 subjects were included, where best cut-off points for dementia and for cognitive impairment were 26/27 (Sn=0.89 (95% CI 0.85-0.91), Sp=0.84 (95% CI, 0.82-0.91)) and 28/29 (Sn=0.79 (95% CI, 0.76-0.81), Sp=0.88 (95% CI, 0.86-0.90)), respectively. Conclusion: Phototest has good diagnostic accuracy for dementia and cognitive impairment. It is brief, simple and can be used in illiterate persons. This makes it suitable for use in primary care settings and/or in subjects with low educational level

Diagnostic accuracy of the Phototest for cognitive impairment and dementia in Argentina

Phototest is a simple, easy and very brief test with theoretical advantages over available dementia screening tests in Spain. The objective of this study was to estimate the diagnostic accuracy of the Phototest for cognitive impairment and dementia and to compare it with that of the MMSE and the Clock Drawing Test (CDT) in an Argentine population. A phase II cross-sectional study of diagnostic tests evaluation was performed in a sample of 30 controls, 61 with amnestic mild cognitive impairment (a-MCI), and 56 with mild Alzheimer type dementia (DAT). The diagnostic accuracy (DA) was assessed in relation to the clinical diagnosis by calculating the area under the ROC curve (UAC), Sensitivity (Sn), and Specificity (Sp).The DA of the Phototest for a-MCI and DAT (0.93 and 0.97 [UAC]) was higher than that of the MMSE and the CDT. The cut-off points of 27/28 for DAT (Sn = 89.29 [78.1–96.0], Sp = 96.67 [82.8–99.9]) and 30/31 for a-MCI (Sn = 85.25 [73.8–93.0], Sp = 90.00 [73.5–97.9]) maximized the sum of Sn and Sp. Phototest correlates significantly with MMSE and CDT. The Phototest is an efficient instrument for the detection of mild dementia or MCI, with good accuracy and good correlation with tests measuring overall cognitive impairment.Fil: Russo, María Julieta. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Provincia de Buenos Aires. Hospital de Berisso; ArgentinaFil: Iturry, Mónica. Gobierno de la Ciudad de Buenos Aires. Hospital "Dr. Abel Zubizarreta"; ArgentinaFil: Sraka, María Alejandra. Provincia de Buenos Aires. Hospital de Berisso; ArgentinaFil: Bartoloni, Leonardo. Gobierno de la Ciudad de Buenos Aires. Hospital "Dr. Abel Zubizarreta"; ArgentinaFil: Carnero Pardo, Cristóbal. Hospital Universitario Virgen de las Nieves; EspañaFil: Allegri, Ricardo Francisco. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin