Brief Cognitive Testing in the Detection and Diagnosis of Clinical Alzheimer-Type Dementia.

Citation metadata

Authors: Aaron Saguil and Emily Buck
Date: Feb. 1, 2021
From: American Family Physician(Vol. 103, Issue 3)
Publisher: American Academy of Family Physicians
Document Type: Article
Length: 1,340 words
Lexile Measure: 1720L

Document controls

Main content

Article Preview :

Key Clinical Issue

In adults with suspected cognitive impairment, what is the utility of brief cognitive testing in detecting clinical Alzheimer-type dementia (ATD) and distinguishing it from mild cognitive impairment (MCI) or normal cognition?

Evidence-Based Answer

The Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), list learning memory test, list delayed recall memory test, and the semantic fluency language test have sensitivities and specificities that are 0.80 or greater in distinguishing clinical ATD from normal cognition. The MoCA is the only stand-alone test with sensitivity and specificity greater than 0.90 for this comparison. (Strength of Recommendation [SOR]: C, based on disease-oriented evidence.) Brief cognitive tests are less accurate in distinguishing clinical ATD from MCI compared with distinguishing it from normal cognitive function. (SOR: C, based on disease-oriented evidence.) Brief cognitive testing alone is insufficient to definitively detect or diagnose clinical ATD. (1) (SOR: C, based on disease-oriented evidence.)

Practice Pointers

In the United States, 5.8 million people 65 years and older (11.4% of this age group) are estimated to have clinical ATD. (2,3) Deaths from stroke and heart disease have decreased over the past two decades while the number of deaths associated with clinical ATD has increased, making it the sixth leading cause of death. Direct costs related to the care of clinical ATD total $305 billion annually, and caregiving by unpaid family members is valued at $244 billion. (2) Given the prevalence, burden, and associated costs of clinical ATD, tools that assist in diagnosing the disease may inform care and improve outcomes.

This Agency for Healthcare Research and Quality review included 57 English-language studies that used validated cognitive tests for distinguishing clinical ATD from normal cognition. Only studies that used established criteria for diagnosing clinical ATD and that were judged to have a low or medium risk of bias were included. More than 80% of patients in these studies were White, and 60% were women. Most studies were retrospective and used the study cohort to set the level of discrimination between clinical ATD...

Source Citation

Source Citation   

Gale Document Number: GALE|A648962590