Le Mini‐Cog pour le diagnostic de la maladie d'Alzheimer et d'autres démences dans un contexte de soins primaires
Referencias
References to studies included in this review
References to studies excluded from this review
Additional references
Characteristics of studies
Characteristics of included studies [ordered by study ID]
Ir a:
| Study characteristics | |||
| Patient sampling | Patients were recruited from 2 cities in Spain, Madrid and Granada. There was 1 site in Madrid and 3 unique sites in Granada. Neuropsychological testing for the reference standard of all participants was completed in a tertiary care setting. The study procedures for the Madrid and Granada sites differed and the information from the Granada site was used in the analysis. | ||
| Patient characteristics and setting | Participants were prospectively identified from primary care by primary care physicians identifying individuals who presented with cognitive complaints or who were suspected of having cognitive disorders by their primary care physicians. Individuals with known cognitive impairment prior to administration of the Mini‐Cog and reference standard were excluded. Number of participants: dementia: 49, no dementia: 93 Participant mean age (SD): 72.1 (11.4) Gender: 103 women, 39 men Education: < primary school: 72 (50.7%) Dementia: 49 (34.5%), no dementia: 93 (65.5) Mean MMSE scores (SD): 19.9 (5.7) | ||
| Index tests | Mini‐Cog was derived from the MMSE and clock drawing test. In the Granada subsample, the Mini‐Cog was performed independent of the reference standard assessment and only information from the Granada sample was used for the analysis. | ||
| Target condition and reference standard(s) | Dementia according to DSM IV TR performed by 2 neurologists | ||
| Flow and timing | Timing of index and reference test unclear | ||
| Comparative | |||
| Notes | |||
| Methodological quality | |||
| Item | Authors' judgement | Risk of bias | Applicability concerns |
| DOMAIN 1: Patient Selection | |||
| Was a consecutive or random sample of patients enrolled? | No | ||
| Was a case‐control design avoided? | Yes | ||
| Did the study avoid inappropriate exclusions? | Yes | ||
| High | High | ||
| DOMAIN 2: Index Test All tests | |||
| Were the index test results interpreted without knowledge of the results of the reference standard? | Yes | ||
| If a threshold was used, was it pre‐specified? | Yes | ||
| Low | Low | ||
| DOMAIN 3: Reference Standard | |||
| Is the reference standards likely to correctly classify the target condition? | Yes | ||
| Were the reference standard results interpreted without knowledge of the results of the index tests? | Yes | ||
| Low | Low | ||
| DOMAIN 4: Flow and Timing | |||
| Was there an appropriate interval between index test and reference standard? | Unclear | ||
| Did all patients receive the same reference standard? | Yes | ||
| Were all patients included in the analysis? | Yes | ||
| Low | |||
| Study characteristics | |||
| Patient sampling | Participants were randomly selected from medical records of 138 primary practices in 1/6 German metropolitan study centres. Patients with baseline dementia were excluded. Participants had to have at least 1 contact with primary care physician within the year preceding enrolment. | ||
| Patient characteristics and setting | Patients who were home‐care visits only, residing in nursing home, or having illness potentially fatal within 3 months, were excluded. Patients with insufficient German‐speaking capabilities, deafness, or blindness were also excluded. All patients within participating practices aged 75‐89 years old were eligible to be selected. Number of participants: dementia: 21, no dementia: 402 Participant mean age (SD): dementia: 82.4 (3.4), no dementia: 82.4 (3.2) Female gender: dementia (68.7%), no dementia (61.9%) Education level: variable, dementia "low education" (62.2%), no dementia "low education" (61.9%) | ||
| Index tests | Mini‐Cog administered with original scoring, as per Borson 2000 | ||
| Target condition and reference standard(s) | Dementia based on the criteria of DSM‐IV, NINCDS‐ADRDA, NINCDS‐AIREN as evaluated in a conference between the interviewer and study co‐ordinator. Evaluation based on SIDAM test results, interview data, informant's information, primary care provider survey and SISCO results. | ||
| Flow and timing | Data available for all except 9 participants. | ||
| Comparative | |||
| Notes | |||
| Methodological quality | |||
| Item | Authors' judgement | Risk of bias | Applicability concerns |
| DOMAIN 1: Patient Selection | |||
| Was a consecutive or random sample of patients enrolled? | Yes | ||
| Was a case‐control design avoided? | Unclear | ||
| Did the study avoid inappropriate exclusions? | No | ||
| High | Low | ||
| DOMAIN 2: Index Test All tests | |||
| Were the index test results interpreted without knowledge of the results of the reference standard? | Yes | ||
| If a threshold was used, was it pre‐specified? | Yes | ||
| Low | Low | ||
| DOMAIN 3: Reference Standard | |||
| Is the reference standards likely to correctly classify the target condition? | Yes | ||
| Were the reference standard results interpreted without knowledge of the results of the index tests? | Unclear | ||
| Unclear | Low | ||
| DOMAIN 4: Flow and Timing | |||
| Was there an appropriate interval between index test and reference standard? | Yes | ||
| Did all patients receive the same reference standard? | Yes | ||
| Were all patients included in the analysis? | No | ||
| Low | |||
| Study characteristics | |||
| Patient sampling | Random sample of primary care patients without known history of dementia. Patients, ≥ 65 years were randomly sampled from electronic medical records of 3 Department of Veterans Affairs primary care clinics close to Durham, N.C., USA. Participants were required to have at least 1 primary care visit in the preceding 18 months. | ||
| Patient characteristics and setting | Excluded individuals with chart diagnosis of dementia or psychotic illness. The remaining population of individuals > 65 years were randomly selected. All potentially eligible female participants were selected due to the small numbers of women in the primary care locations. Patients with severe visual and hearing impairment, unable to recall an informant for supplemental cognitive history, active alcohol or drug abuse, unstable medical conditions and insufficient English fluency were excluded from the study. Number of participants: dementia: 21, no dementia: 362 Participant mean age (SD): dementia: 79.0 (5.1), no dementia: 74.2 (6.5) Female gender number (%): dementia: 1 (4.8%), no dementia: 30 (8.3%) Years of education (SD): dementia: 11.1 (3.9), no dementia: 13.5 (3.2) | ||
| Index tests | Mini‐Cog scored with original scoring algorithm, as per Borson 2000 | ||
| Target condition and reference standard(s) | Diagnosis of dementia based on the criteria of DSM‐IV‐TR, NINDS‐ADRDA, NINCDS‐AIREN. Evaluated by a consensus panel of specialists from neurology, internal medicine, geriatric psychiatry and cognitive neuroscience. Evaluations were based on clinical interview, history by informant, neuropsychological testing, standardized neurology exam and review of the electronic medical record. | ||
| Flow and timing | Data were not available for 9/639 patients selected. 1242 patients were contacted, patients with a variable informant, who matched the eligibility guidelines and showed up for the evaluation totaled 639. | ||
| Comparative | |||
| Notes | |||
| Methodological quality | |||
| Item | Authors' judgement | Risk of bias | Applicability concerns |
| DOMAIN 1: Patient Selection | |||
| Was a consecutive or random sample of patients enrolled? | Yes | ||
| Was a case‐control design avoided? | Yes | ||
| Did the study avoid inappropriate exclusions? | Yes | ||
| Low | Low | ||
| DOMAIN 2: Index Test All tests | |||
| Were the index test results interpreted without knowledge of the results of the reference standard? | Yes | ||
| If a threshold was used, was it pre‐specified? | Yes | ||
| Low | Low | ||
| DOMAIN 3: Reference Standard | |||
| Is the reference standards likely to correctly classify the target condition? | Yes | ||
| Were the reference standard results interpreted without knowledge of the results of the index tests? | Yes | ||
| Low | Low | ||
| DOMAIN 4: Flow and Timing | |||
| Was there an appropriate interval between index test and reference standard? | Yes | ||
| Did all patients receive the same reference standard? | Yes | ||
| Were all patients included in the analysis? | Yes | ||
| Low | |||
| Study characteristics | |||
| Patient sampling | Participants aged ≥ 70 years without prior cognitive impairment, who were not terminally ill were randomly selected from 7 Veteran Affairs Medical Centers during routinely scheduled primary care appointments. Individuals who were assessed by their primary care physicians as possibly requiring additional evaluation were then invited to receive both the index test and evaluations to complete the reference standard evaluation. | ||
| Patient characteristics and setting | Veterans, ≥ 70 years, in stable health and able to complete the screen and without baseline cognitive impairment were eligible. | ||
| Index tests | Mini‐Cog with less stringent criteria of ≤ 3/5 for a positive screen to increase sensitivity | ||
| Target condition and reference standard(s) | Dementia based on DSM‐IV diagnostic criteria, using information from the results of the Montreal Cognitive Assessment, Neuropsychiatric Inventory (NPI‐Q), the dependence scale, driving screen, caregiver needs assessment, cognitive performance test, performance‐based functional assessment, brain imaging. Final review of all tests in consensus conference to determine the diagnosis. | ||
| Flow and timing | 8342 people were randomly selected for screening and 8063 agreed to participate. 698 either failed the screening and accepted further evaluation or passed the screening and requested further evaluation; these received both the index and reference standards. 1501 failed the screen and refused further testing and 5864 passed screening and did not request further evaluation. | ||
| Comparative | |||
| Notes | |||
| Methodological quality | |||
| Item | Authors' judgement | Risk of bias | Applicability concerns |
| DOMAIN 1: Patient Selection | |||
| Was a consecutive or random sample of patients enrolled? | Yes | ||
| Was a case‐control design avoided? | Yes | ||
| Did the study avoid inappropriate exclusions? | Yes | ||
| High | High | ||
| DOMAIN 2: Index Test All tests | |||
| Were the index test results interpreted without knowledge of the results of the reference standard? | Yes | ||
| If a threshold was used, was it pre‐specified? | Yes | ||
| Low | Low | ||
| DOMAIN 3: Reference Standard | |||
| Is the reference standards likely to correctly classify the target condition? | Yes | ||
| Were the reference standard results interpreted without knowledge of the results of the index tests? | Unclear | ||
| Unclear | Low | ||
| DOMAIN 4: Flow and Timing | |||
| Was there an appropriate interval between index test and reference standard? | Unclear | ||
| Did all patients receive the same reference standard? | No | ||
| Were all patients included in the analysis? | No | ||
| High | |||
DSM IV: Diagnostic and Statistical Manual of Mental Disorders Fourth Edition; DSM IV TR: Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (text revision); MMSE: Mini‐Mental State Exam; NINCDS‐ADRDA: National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association; NINDS‐AIREN: National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherche et l'Enseignement en Neurosciences; SIDAM: Structured Interview for the Diagnosis of Dementia of the Alzheimer Type, Multi‐Infarct Dementia, and Dementias of Other Aetiology According to DSM‐III‐R, DSM‐IV, and ICD‐10; SISCO: SIDAM score.
Characteristics of excluded studies [ordered by study ID]
Ir a:
| Study | Reason for exclusion |
| Setting other than primary care | |
| Setting other than primary care | |
| Did not use the Mini‐Cog as the index test | |
| Did not use the Mini‐Cog as the index test. Participants did not receive gold standard evaluation using standardized diagnostic criteria. Did not use the Mini‐Cog in a primary care setting | |
| Did not receive gold standard evaluation using standardized diagnostic criteria | |
| Did not use the Mini‐Cog in a primary care setting | |
| Insufficient information. Request for additional information denied | |
| Not online. Request for additional information denied | |
| Did not use the Mini‐Cog in a primary care setting | |
| Did not use the Mini‐Cog in a primary care setting | |
| Did not use the Mini‐Cog in a primary care setting | |
| Did not receive gold standard evaluation using standardized diagnostic criteria | |
| Did not use reference standard for dementia | |
| Did not use reference standard for dementia | |
| Did not use the Mini‐Cog in a primary care setting | |
| Did not use the Mini‐Cog as index test. Participants were not without dementia or cognitive complaints at baseline. Did not receive gold standard evaluation using standardized diagnostic criteria | |
| Did not use the Mini‐Cog as an index test. Was not a cross‐sectional study | |
| Did not use the Mini‐Cog in a primary care setting | |
| Did not use reference standard for dementia | |
| Setting other than primary care | |
| Was not a cross‐sectional study | |
| Insufficient information available because both Mini‐Cog and FAQ results were combined | |
| Did not receive gold standard evaluation using standardized diagnostic criteria | |
| Unclear if Mini‐Cog was used as an index test | |
| Did not receive gold standard evaluation using standardized diagnostic criteria | |
| Did not receive gold standard evaluation using standardized diagnostic criteria | |
| Was not a cross‐sectional study | |
| Did not use Mini‐Cog as an index test. Participants were not without dementia or cognitive complaints at baseline. Did not receive gold standard evaluation using standardized diagnostic criteria | |
| Did not use Mini‐Cog as an index test. Participants were not without dementia or cognitive complaints at baseline. Did not receive gold standard evaluation using standardized diagnostic criteria | |
| Did not use Mini‐Cog as an index test. Participants were not without dementia or cognitive complaint at baseline. Did not receive gold standard evaluation using standardized diagnostic criteria. Was not a cross‐sectional study. Did not use the Mini‐Cog in a primary care setting | |
| Did not use the reference standard for dementia | |
| Did not receive gold standard evaluation using standardized diagnostic criteria | |
| Did not use the Mini‐Cog in a primary care setting | |
| Did not use the Mini‐Cog in a primary care setting | |
| Did not use the Mini‐Cog as an index test. Participants were not without dementia or cognitive complaint at baseline. Did not receive gold standard evaluation using standardized diagnostic criteria. Was not a cross‐sectional study | |
| Did not use the reference standard for dementia | |
| Did not use the Mini‐Cog as an index test. Did not receive gold standard evaluation using standardized diagnostic criteria. Was not a cross‐sectional study. Unclear if participants were without dementia or cognitive complaint at baseline | |
| Setting other than primary care | |
| Participants were not without dementia and cognitive complaint at baseline. Did not receive gold standard evaluation using standardized diagnostic criteria. Was not a cross‐sectional study | |
| Unclear if the participants were without dementia and cognitive complaint at baseline. Unclear if a gold standard evaluation using standardized diagnostic criteria was used. Did not use the Mini‐Cog in a primary care setting | |
| Did not use the Mini‐Cog as an index test. Participants were not without dementia and cognitive complaint at baseline. Did not receive gold standard evaluation using standardized diagnostic criteria. Was not a cross‐sectional study. Did not use the Mini‐Cog in a primary care setting | |
| Setting other than primary care | |
| Setting other than primary care | |
| Lack of reference test for dementia | |
| Did not receive gold standard evaluation using standardized diagnostic criteria | |
| Did not receive gold standard evaluation using standardized diagnostic criteria | |
| Did not receive gold standard evaluation using standardized diagnostic criteria | |
| Setting other than primary care | |
| Insufficient information available to calculate sensitivity and specificity | |
| Participants were not without dementia or cognitive complaint at baseline | |
| Did not use the Mini‐Cog in a primary care setting | |
| Setting other than primary care | |
| Setting other than primary care | |
| Lack of reference test | |
| Setting over than primary care |
FAQ: frequently asked questions
Data
Presented below are all the data for all of the tests entered into the review.
| Test | No. of studies | No. of participants |
| 1 Mini‐Cog Show forest plot | 4 | 1517 |
| Test 1  Mini‐Cog. | ||
Study flow diagram
Risk of bias and applicability concerns graph: review authors' judgements about each domain presented as percentages across included studies
Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study
Forest plot of Analysis 1 Mini‐Cog
| Mini‐Cog for the diagnosis of Alzheimer's disease dementia and other dementias within a primary care setting | ||||
| Population | The study populations were sampled from participants identified in primary care settings. | |||
| Setting | The primary care setting was identified as representing a sample that would be presenting to primary care settings where the Mini‐Cog might be used as a screening test to identify individuals who may benefit from additional evaluation. Studies that identified individuals in primary care where they received both the index test and a reference standard were used. | |||
| Indext test | The Mini‐Cog performed in insolation or scored based on results on the clock drawing test or three‐word recall were included. | |||
| Reference Standard | Clinical diagnosis of dementia was made using recognized standard diagnostic criteria. | |||
| Studies | Cross‐sectional studies were included, case control studies were excluded | |||
| Study | Accuracy (95% CI) | Number of participants | Dementia prevalence | Implications |
| Sensitivity: 1.00 (0.93 to 1.00) Specificity: 0.40 (0.30 to 0.50) | 142 | 34.5% | Participants were sampled including individuals who did have a pre‐existing history of dementia or cognitive impairment prior to assessment with the Mini‐Cog and reference standard but all participants had to have cognitive complaints suggestive of possible undiagnosed dementia or cognitive impairment. | |
| Sensitivity: 1.00 (0.84 to 1.00) Specificity: 0.85 (0.81 to 0.89) | 423 | 5.0% | The study excluded individuals with dementia at baseline, and those included in the study received a 36 month follow up assessment. Thus participants in the sample who were diagnosed with dementia were in the early stages of the disease. | |
| Sensitivity: 0.76 (0.53 to 0.92) Specificity: 0.73 (0.68 to 0.77) | 383 | 5.5% | Study involved evaluation of individuals in primary care settings without a documented history of dementia recorded at baseline. | |
| Sensitivity: 0.84 (0.81 to 0.87) Specificity: 0.27 (0.16 to 0.41) | 569 | 90.3% | Individuals with documented cognitive impairment were excluded from screening. Sampling involved screening of all participants in primary care and then offering further evaluation to individuals who either screened positive or negative on initial screening and who also agreed to have further evaluation. | |
| CI: confidence interval | ||||
| Study ID | Country | Participants (N) | Setting | Mini‐Cog scoring | Reference standard for dementia diagnosis | Dementia prevalence | Notes |
| Spain | 142 | 1 primary care location in Madrid and 3 primary care locations in Granada, only data from the Granada site was included | Standard scoring | DSM IV TR | 34.5% | The clock drawing test was incorporated into the reference standard at the Madrid site, data are presented for the Granada sites only. Screening was administered by professionals (no further specification) except for the clock drawing test component in Madrid, which was performed by a neurologist. | |
| Germany | 423 | Participants were randomly selected from 138 study centres in 6 metropolitan areas in Germany although study reports information from 29 sites recruited from Dusseldorf region | Standard scoring | DSM IV | 5.0% | Individuals with known dementia were excluded from the study. Study evaluated accuracy of the Mini‐Cog in detecting incident dementia at 36 months' follow‐up from enrolment. Screening tests were administered by a trained physician or psychologist. | |
| USA | 383 | Primary care locations affiliated with the Veterans Affairs near Durham, North Carolina | Standard scoring | DSM IV and NINCDS‐ADRDA | 5.5% | Excluded individuals with a known prior history of dementia based on diagnoses recorded in charts. The Mini‐Cog was administered by a research assistant. | |
| USA | 569 | 7 primary care settings affiliated with Veterans Affairs in Minneapolis, Minnesota | Standard scoring | DSM IV | 90.3% | Participants were first screened for possible dementia by trained advanced practice registered nurses based on interview during routine visit with those who initially screened positive being offered additional evaluation with the index and reference standards. Some individuals who did not screen positive at the initial interview requested and received additional evaluation. | |
| DSM IV: Diagnostic and Statistical Manual of Mental Disorders Fourth Edition; DSM IV TR: Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (text revision); NINCDS‐ADRDA: Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association | |||||||
| Test | No. of studies | No. of participants |
| 1 Mini‐Cog Show forest plot | 4 | 1517 |
