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The comparative diagnostic accuracy of the Mini Mental State Examination (MMSE) and the General Practitioner assessment of Cognition (GPCOG) for identifying dementia in primary care: a systematic review protocol.

ABSTRACT: Background:Improved dementia identification is a global health priority, and general practitioners (GPs) are often the first point of contact for people with concerns about their cognition. However, GPs often express uncertainty in using assessment tools and the evidence based on which tests are most accurate in identifying dementia is unclear. In particular, there is little certainty around how the accuracy of available brief cognitive assessments compares within a clinical family practice setting.Grounded in existing brief cognitive assessment evidence, we will compare the diagnostic test accuracy of the Mini Mental State Examination (MMSE) to the General Practitioner Assessment of Cognition (GPCOG) against the best available reference standard when used within a family practice setting. Methods:We will employ robust systematic review methods to assess studies of diagnostic accuracy where both the MMSE and GPCOG have been evaluated as direct comparisons, i.e. within the same study population. This approach will enable us to minimise between-study heterogeneity, to eliminate the risk of bias due to confounding and increase the opportunity to make clinically useful and useable comparisons of diagnostic accuracy across both the MMSE and GPCOG. This systematic review will be conducted using a pragmatic search strategy, refining searches that build upon studies identified as part of our overview of systematic reviews of the diagnostic accuracy of brief cognitive assessments for identifying dementia in primary care. Discussion:Through this systematic review, we aim to improve existing evidence on how the diagnostic accuracy of MMSE and GPCOG compares when used to identify dementia within the family practice setting. We also aim to make clinical practice recommendations based upon the variations in diagnostic accuracy identified between the MMSE and GPCOG.

SUBMITTER: Hunt HA

PROVIDER: S-EPMC6460787 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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The comparative diagnostic accuracy of the Mini Mental State Examination (MMSE) and the General Practitioner assessment of Cognition (GPCOG) for identifying dementia in primary care: a systematic review protocol.

Hunt Harriet A HA Van Kampen Sanne S Takwoingi Yemisi Y Llewellyn David J DJ Pearson Mark M Hyde Christopher J CJ

Diagnostic and prognostic research 20170602

<h4>Background</h4>Improved dementia identification is a global health priority, and general practitioners (GPs) are often the first point of contact for people with concerns about their cognition. However, GPs often express uncertainty in using assessment tools and the evidence based on which tests are most accurate in identifying dementia is unclear. In particular, there is little certainty around how the accuracy of available brief cognitive assessments compares within a clinical family pract ...[more]

PMID: 31093543

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Project description:BackgroundThe Clinical Dementia Rating (CDR) and Mini-Mental State Examination (MMSE) are useful screening tools for mild cognitive impairment (MCI). However, these tests require qualified in-person supervision and the CDR can take up to 60 min to complete. We developed a digital cognitive screening test (M-CogScore) that can be completed remotely in under 5 min without supervision. We set out to validate M-CogScore in head-to-head comparisons with CDR and MMSE.MethodsTo ascertain the validity of the M-CogScore, we enrolled participants as healthy controls or impaired cognition, matched for age, sex, and education. Participants completed the 30-item paper MMSE Second Edition Standard Version (MMSE-2), paper CDR, and smartphone-based M-CogScore. The digital M-CogScore test is based on time-normalised scores from smartphone-adapted Stroop (M-Stroop), digit-symbols (M-Symbols), and delayed recall tests (M-Memory). We used Spearman's correlation coefficient to determine the convergent validity between M-CogScore and the 30-item MMSE-2, and non-parametric tests to determine its discriminative validity with a CDR label of normal (CDR 0) or impaired cognition (CDR 0.5 or 1). M-CogScore was further compared to MMSE-2 using area under the receiver operating characteristic curves (AUC) with corresponding optimal cut-offs.Results72 participants completed all three tests. The M-CogScore correlated with both MMSE-2 (rho = 0.54, p < 0.0001) and impaired cognition on CDR (Mann Whitney U = 187, p < 0.001). M-CogScore achieved an AUC of 0.85 (95% bootstrapped CI [0.80, 0.91]), when differentiating between normal and impaired cognition, compared to an AUC of 0.78 [0.72, 0.84] for MMSE-2 (p = 0.21).ConclusionDigital screening tests such as M-CogScore are desirable to aid in rapid and remote clinical cognitive evaluations. M-CogScore was significantly correlated with established cognitive tests, including CDR and MMSE-2. M-CogScore can be taken remotely without supervision, is automatically scored, has less of a ceiling effect than the MMSE-2, and takes significantly less time to complete.

Project description:BackgroundThe Mini-Mental State Examination-Second Edition (MMSE-2) consists of three visions: a brief version (MMSE-2:BV), a standard version (MMSE-2:SV), and an expanded version (MMSE-2: EV). Each version was equipped with alternate forms (blue and red). There was a lack of evidence on the practice effect and test-retest reliability of the three versions of the MMSE-2, limiting its utility in both clinical and research settings. The purpose of this study was to examine the practice effect and test-retest reliability of the MMSE-2 in people with dementia.MethodsOne hundred and twenty participants were enrolled, of which 60 were administered with the blue form twice (i.e., the same-form group, [SF group]) and 60 were administered with the blue form first and then the red form (alternate-form group, [AF group]). The practice effect was evaluated using a paired t-test and Cohen's d. The test-retest reliability was examined using the intraclass correlation coefficient (ICC).ResultsFor the practice effects, in the SF group, no statistically significant differences were found for the MMSE-2:BV and MMSE-2: EV total scores and eight subtests (p = 0.061-1.000), except for the MMSE-2:SV total score (p = 0.029). In the AF group, no statistically significant differences were found for all three versions of the total scores and subtests (p = 0.106-1.000), except for the visual-constructional ability subtest (p = 0.010). Cohen's d of all three versions' total scores and subtests were 0.00-0.20 and 0.00-0.26 for SF group and AF group, respectively. For the test-retest reliability, ICC values for all three versions and eight subtests in SF and AF groups were 0.60-0.93 and 0.56-0.93, respectively.ConclusionOur results demonstrated that the practice effect could be minimized when alternate forms of the MMSE-2 were used. The MMSE-2 had good to excellent test-retest reliability, except for three subtests (i.e., visual-constructional ability, registration, and recall). Caution should be taken when interpreting the results of visual-constructional ability, registration, and recall subtests of the MMSE-2.

Project description:Cognitive scales are used frequently in geriatric research and practice. These instruments are constructed with underlying assumptions that are a part of their validation process. A common measurement scale used in older adults is the Folstein Mini Mental State Exam (MMSE). The MMSE was designed to screen for cognitive impairment and is used often in geriatric research. This paper has three aims. Aim one was to explore four potential threats to validity in the use of the MMSE: (1) administering the exam without meeting the underlying assumptions, (2) not reporting that the underlying assumptions were assessed prior to test administration, (3) use of variable and inconsistent cut-off scores for the determination of presence of cognitive impairment, and (4) failure to adjust the scores based on the demographic characteristics of the tested subject. Aim two was to conduct a literature search to determine if the assumptions of (1) education level assessment, (2) sensory assessment, and (3) language fluency were being met and clearly reported in published research using the MMSE. Aim three was to provide recommendations to minimalize threats to validity in research studies that use cognitive scales, such as the MMSE. We found inconsistencies in published work in reporting whether or not subjects meet the assumptions that underlie a reliable and valid MMSE score. These inconsistencies can pose threats to the reliability of exam results. Fourteen of the 50 studies reviewed reported inclusion of all three of these assumptions. Inconsistencies in reporting the inclusion of the underlying assumptions for a reliable score could mean that subjects were not appropriate to be tested by use of the MMSE or that an appropriate test administration of the MMSE was not clearly reported. Thus, the research literature could have threats to both validity and reliability based on misuse of or improper reported use of the MMSE. Six recommendations are provided to minimalize these threats in future research.

Dataset Information

The comparative diagnostic accuracy of the Mini Mental State Examination (MMSE) and the General Practitioner assessment of Cognition (GPCOG) for identifying dementia in primary care: a systematic review protocol.

Publications

The comparative diagnostic accuracy of the Mini Mental State Examination (MMSE) and the General Practitioner assessment of Cognition (GPCOG) for identifying dementia in primary care: a systematic review protocol.

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