Comparing approaches to optimize cut-off scores for short cognitive screening instruments in mild cognitive impairment and dementia

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dc.contributor.author O'Caoimh, Rónán
dc.contributor.author Gao, Yang
dc.contributor.author Svendovski, Anton
dc.contributor.author Gallagher, Paul
dc.contributor.author Eustace, Joseph
dc.contributor.author Molloy, D. William
dc.date.accessioned 2018-05-02T10:16:26Z
dc.date.available 2018-05-02T10:16:26Z
dc.date.issued 2017
dc.identifier.citation O’Caoimh, R., Gao, Y., Svendovski, A., Gallagher, P., Eustace, J. and Molloy, D. W. (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, pp. 123-133. doi: 10.3233/JAD-161204 en
dc.identifier.volume 57
dc.identifier.issued 1
dc.identifier.startpage 123
dc.identifier.endpage 133
dc.identifier.issn 1387-2877
dc.identifier.uri http://hdl.handle.net/10468/5944
dc.identifier.doi 10.3233/JAD-161204
dc.description.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. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher IOS Press en
dc.relation.uri https://content.iospress.com/articles/journal-of-alzheimers-disease/jad161204
dc.rights © 2017, IOS Press and the authors. All rights reserved This article is published online with Open Access and distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC 4.0). en
dc.rights.uri https://creativecommons.org/licenses/by-nc/4.0/
dc.subject Cognitive screening en
dc.subject Cut-offs en
dc.subject Dementia en
dc.subject Mild cognitive impairment en
dc.subject Quick mild cognitive impairment screen en
dc.subject Standardized mini-mental state examination en
dc.title Comparing approaches to optimize cut-off scores for short cognitive screening instruments in mild cognitive impairment and dementia en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Ronan O’Caoimh, Centre of Gerontology & Rehabilitation, University College Cork, Cork, Ireland. +353-21-490-3000 Email: rocaoimh@hotmail.com en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.contributor.funder Canadian Institutes of Health Research
dc.contributor.funder Atlantic Philanthropies
dc.description.status Peer reviewed en
dc.identifier.journaltitle Journal of Alzheimer's Disease en
dc.internal.IRISemailaddress rocaoimh@hotmail.com en


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© 2017, IOS Press and the authors. All rights reserved This article is published online with Open Access and distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC 4.0). Except where otherwise noted, this item's license is described as © 2017, IOS Press and the authors. All rights reserved This article is published online with Open Access and distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC 4.0).
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