Comparing approaches to optimize cut-off scores for short cognitive screening instruments in mild cognitive impairment and dementia
View/ Open
Full Text
Date
2017-03-04Author
O’Caoimh, Rónán
Gao, Yang
Svendovski, Anton
Gallagher, Paul
Eustace, Joseph
Molloy, D. William
Metadata
Show full item recordUsage
This item's downloads: 0 (view details)
Cited 29 times in Scopus (view citations)
Recommended Citation
O’Caoimh, Rónán; Gao, Yang; Svendovski, Anton; Gallagher, Paul; Eustace, Joseph; Molloy, D. William (2017). Comparing approaches to optimize cut-off scores for short cognitive screening instruments in mild cognitive impairment and dementia. Journal of Alzheimer's Disease 57 (1), 123-133
Published Version
Abstract
Background: Although required to improve the usability of cognitive screening instruments (CSIs), the use of cut-off scores is controversial yet poorly researched.
Objective: To explore cut-off scores for two short CSIs: the Standardized Mini-Mental State Examination (SMMSE) and Quick Mild Cognitive Impairment (Qmci) screen, describing adjustments in scores for diagnosis (MCI or dementia), age (<=, > 75 years), and education (<, >= 12 years), comparing two methods: the maximal accuracy approach, derived from receiver operating characteristic curves, and Youden's Index.
Methods: Pooled analysis of assessments from patients attending memory clinics in Canada between 1999-2010 : 766 with mild cognitive impairment (MCI) and 1,746 with dementia, and 875 normal controls.
Results: The Qmci was more accurate than the SMMSE in differentiating controls from MCI or cognitive impairment (MCI and dementia). Employing the maximal accuracy approach, the optimal SMMSE cut-off for cognitive impairment was < 28/30 (AUC 0.86, sensitivity 74%, specificity 88%) versus < 63/100 for the Qmci (AUC 0.93, sensitivity 85%, specificity 85%). Using Youden's Index, the optimal SMMSE cut-off remained < 28/30 but fell slightly to < 62/100 for the Qmci (sensitivity 83%, specificity 87%). The optimal cut-off for MCI was < 29/30 for the SMMSE and < 67/100 for the Qmci, irrespective of technique. The maximal accuracy approach generally produced higher Qmci cut-offs than Youden's Index, both requiring adjustment for age and education. There were no clinically meaningful differences in SMMSE cut- off scores by age and education or method employed.
Conclusion: Caution should be exercised selecting cut-offs as these differ by age, education, and method of derivation, with the extent of adjustment varying between CSIs.
Except where otherwise noted, this item's license is described as Attribution-NonCommercial-NoDerivs 3.0 Ireland
Related items
Showing items related by title, author, creator and subject.
-
Screening for mild cognitive impairment: comparison of “mci specific” screening instruments
O’Caoimh, Rónán; Timmons, Suzanne; Molloy, D. William (IOS Press, 2016-03-15)Background: Sensitive and specific instruments are required to screen for cognitive impairment (CI) in busy clinical practice. The Montreal Cognitive Assessment (MoCA) is widely validated but few studies compare it to tests ... -
Computerised working memory‐based cognitive remediation therapy does not affect Reading the Mind in The Eyes test performance or neural activity during a Facial Emotion Recognition test in psychosis
Mothersill, David; Dillon, Rachael; Hargreaves, April; Castorina, Marco; Furey, Emilia; Fagan, Andrew J.; Meaney, James F.; Fitzmaurice, Brian; Hallahan, Brian; McDonald, Colm; Wykes, Til; Corvin, Aiden; Robertson, Ian H.; Donohoe, Gary (Wiley, 2018-05-27)Working memory-based cognitive remediation therapy (CT) for psychosis has recently been associated with broad improvements in performance on untrained tasks measuring working memory, episodic memory and IQ, and changes in ... -
Cognitive course in first-episode psychosis and clinical correlates: A 4year longitudinal study using the MATRICS Consensus Cognitive Battery.
Kenney, Joanne; Anderson-Schmidt, Heike; Scanlon, Cathy; Arndt, Sophia; Scherz, Elisabeth; McInerney, Shane; McFarland, John; Byrne, Fintan; Ahmed, Mohamed; Donohoe, Gary; Hallahan, Brian; McDonald, Colm; Cannon, Dara M. (2015-09-26)While cognitive impairments are prevalent in first-episode psychosis, the course of these deficits is not fully understood. Most deficits appear to remain stable, however there is uncertainty regarding the trajectory of ...