Comparing approaches to optimize cut-off scores for short cognitive screening instruments in mild cognitive impairment and dementia
dc.contributor.author | O'Caoimh, Rónán | |
dc.contributor.author | Gao, Yang | |
dc.contributor.author | Svendovski, Anton | |
dc.contributor.author | Gallagher, Paul F. | |
dc.contributor.author | Eustace, Joseph A. | |
dc.contributor.author | Molloy, D. William | |
dc.contributor.funder | Canadian Institutes of Health Research | |
dc.contributor.funder | Atlantic Philanthropies | |
dc.date.accessioned | 2018-05-02T10:16:26Z | |
dc.date.available | 2018-05-02T10:16:26Z | |
dc.date.issued | 2017 | |
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.description.status | Peer reviewed | en |
dc.description.version | Published Version | en |
dc.format.mimetype | application/pdf | en |
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.doi | 10.3233/JAD-161204 | |
dc.identifier.endpage | 133 | |
dc.identifier.issn | 1387-2877 | |
dc.identifier.issued | 1 | |
dc.identifier.journaltitle | Journal of Alzheimer's Disease | en |
dc.identifier.startpage | 123 | |
dc.identifier.uri | https://hdl.handle.net/10468/5944 | |
dc.identifier.volume | 57 | |
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 |